Which of the following adverse effects is associated with daptomycin?

A 72-year-old male is admitted to the hospital from

a nursing home with severe pneumonia. He was

recently discharged from the hospital 1 week ago

after open heart surgery. The patient has no known

allergies. Which of the following regimens is most

appropriate for empiric coverage of methicillin-

resistant Staphylococcus aureus and Pseudomonas

aeruginosa in this patient?

A 23-year-old male presents with acute appendicitis that ruptures shortly after admission. He is taken to the operating room for surgery, and postsurgical cultures reveal Escherichia coli and Bacteroides fragilis, susceptibilities pending. Which of the following provides adequate empiric coverage of these two pathogens?

A 68-year-old male presents from a nursing home with fever, increased urinary frequency and urgency, and mental status changes. He has a penicillin allergy of anaphylaxis. Which of the following β-lactams is the most appropriate choice for gram-negative coverage of this patient’s urinary tract infection?

A 25-year-old male presents to the urgent care center with a painless sore on his genitals that started 1 to 2 weeks ago. He reports unprotected sex with a new partner about a month ago. A blood test confirms the patient has Treponema pallidum. Which of the following is the drug of choice for the treatment of this patient’s infection as a single dose?

A 20-year-old female presents to the emergency room with headache, stiff neck, and fever for 2 days and is diagnosed with meningitis. Which of the following agents is the best choice for the treatment of meningitis in this patient?

Which of the following cephalosporins has activity against gram-negative anaerobic pathogens like Bacteroides fragilis?

In which of the following cases would it be appropriate to use telavancin?

An 18-year-old female presents to the urgent care clinic with urinary frequency, urgency, and fever for the past 3 days. Based on symptoms and a urinalysis, she is diagnosed with a urinary tract infection. Cultures reveal Enterococcus faecalis that is pan sensitive. Which of the following is an appropriate oral option to treat the urinary tract infection in this patient?

The primary mechanism of antibacterial action of the penicillins involves inhibition of

A 33-year-old man was seen in a clinic with a complaint of dysuria and urethral discharge of yellow pus. He had a painless clean-based ulcer on the penis and non-tender enlargement of the regional lymph nodes. Gram stain of the urethral exudate showed gram-negative diplococci within PMNs. The patient informed the clinic staff that he was unemployed and had not eaten a meal for 2 d. The most appropriate treatment of gonorrhea in this patient is:

A 33-year-old man was seen in a clinic with a complaint of dysuria and urethral discharge of yellow pus. He had a painless clean-based ulcer on the penis and non-tender enlargement of the regional lymph nodes. Gram stain of the urethral exudate showed gram-negative diplococci within PMNs. He receives an intrumuscular dose of ceftriaxone. Immunofluorescent microscopic examination of fluid expressed from the penile chancre of this patient revealed treponemes. Because he appears to be infected with Treponema pallidum, the best course of action would be to

Which of the following statements about β-lactam antibiotics is false?

A 36-year-old woman recently treated for leukemia is admitted to the hospital with malaise, chills, and high fever. Gram stain of blood reveals the presence of gram-negative bacilli. The initial diagnosis is bacteremia, and parenteral antibiotics are indicated. The records of the patient reveal that she had a severe urticarial rash, hypotension, and respiratory difficulty after oral penicillin V about 6 mo ago. The most appropriate drug regimen for empiric treatment is

A 52-year-old man (weight 70 kg) is brought to the hospital emergency department in a confused and delirious state. He has had an elevated temperature for more than 24 h, during which time he had complained of a severe headache and had suffered from nausea and vomiting. Lumbar puncture reveals an elevated opening pressure, and cerebrospinal fluid findings include elevated protein, decreased glucose, and increased neutrophils. Gram stain of a smear of cerebrospinal fluid reveals gram-positive diplococci, and a preliminary diagnosis is made of purulent meningitis. The microbiology report informs you that for approximately 15% of S pneumoniae isolates in the community, the minimal inhibitory concentration for penicillin G is 20 mcg/mL. Treatment of this patient should be initiated immediately with intravenous administration of

Resistance of pneumococci to penicillin G is due to

A 82-year-old man (weight 70 kg) is brought to the hospital emergency department in a confused and delirious state. He has had an elevated temperature for more than 24 h, during which time he had complained of a severe headache and had suffered from nausea and vomiting. Gram stain of the smear of cerebrospinal fluid has revealed gram-positive rods resembling diphtheroids (L. monocytogenes). The antibiotic regimen for empiric treatment would include

A patient needs antibiotic treatment for native valve, culture-positive infective enterococcal endocarditis. His medical history includes a severe anaphylactic reaction to penicillin G during the last year. The best approach would be treatment with

Which statement about vancomycin is accurate?

Which of the following antibiotic combinations is inappropriate based on antagonism at the same site of action?

Children younger than 8 years of age should not receive tetracyclines because these agents:

A 30-year-old pregnant female has cellulitis caused by MRSA. Which of the following antibiotics would be the most appropriate option for outpatient therapy?

A patient is being discharged from the hospital on a 3-week course of clindamycin. Which of the following potential adverse effects should be discussed with her?

A 4-year-old child is brought to the hospital after ingesting pills that a parent had used for bacterial dysentery when traveling outside the United States. The child has been vomiting for more than 24 h and has had diarrhea with green stools. She is now lethargic with an ashen color. Other signs and symptoms include hypothermia, hypotension, and abdominal distention. The drug most likely to be the cause of this problem is

The mechanism of antibacterial action of tetracycline involves

Clarithromycin and erythromycin have very similar spectra of antimicrobial activity. The major advantage of clarithromycin is that it

The primary mechanism of resistance of gram-positive organisms to macrolide antibiotics including erythromycin is

A 26-year-old woman was treated for a suspected chlamydial infection at a neighborhood clinic. She was given a prescription for oral doxycycline to be taken for 14 d. Three weeks later, she returned to the clinic with a mucopurulent cervicitis. On questioning she admitted not having the prescription filled. The best course of action at this point would be to

A 55-year-old patient with a prosthetic heart valve is to undergo a periodontal procedure involving scaling and root planing. Several years ago, the patient had a severe allergic reaction to procaine penicillin G. Regarding prophylaxis against bacterial endocarditis, which one of the following drugs taken orally is most appropriate?

A 24-year-old woman comes to a clinic with complaints of dry cough, headache, fever, and malaise, which have lasted 3 or 4 d. She appears to have some respiratory difficulty, and chest examination reveals rales but no other obvious signs of pulmonary involvement. However, extensive patchy infiltrates are seen on chest x-ray film. Gram stain of expectorated sputum fails to reveal any bacterial pathogens. The patient mentions that a colleague at work had similar symptoms to those she is experiencing. The patient has no history of serious medical problems. She takes loratadine for allergies and supplementary iron tablets, and she drinks at least 6 cups of caffeinated coffee per day. The physician makes an initial diagnosis of community- acquired pneumonia.

Regarding the treatment of this patient, which of the following drugs is most suitable?

A 24-year-old woman comes to a clinic with complaints of dry cough, headache, fever, and malaise, which have lasted 3 or 4 d. She appears to have some respiratory difficulty, and chest examination reveals rales but no other obvious signs of pulmonary involvement. However, extensive patchy infiltrates are seen on chest x-ray film. Gram stain of expectorated sputum fails to reveal any bacterial pathogens. The patient mentions that a colleague at work had similar symptoms to those she is experiencing. The patient has no history of serious medical problems. She takes loratadine for allergies and supplementary iron tablets, and she drinks at least 6 cups of caffeinated coffee per day. The physician makes an initial diagnosis of community- acquired pneumonia.

If this patient were to be treated with erythromycin, she should:

A 24-year-old woman comes to a clinic with complaints of dry cough, headache, fever, and malaise, which have lasted 3 or 4 d. She appears to have some respiratory difficulty, and chest examination reveals rales but no other obvious signs of pulmonary involvement. However, extensive patchy infiltrates are seen on chest x-ray film. Gram stain of expectorated sputum fails to reveal any bacterial pathogens. The patient mentions that a colleague at work had similar symptoms to those she is experiencing. The patient has no history of serious medical problems. She takes loratadine for allergies and supplementary iron tablets, and she drinks at least 6 cups of caffeinated coffee per day. The physician makes an initial diagnosis of community- acquired pneumonia.

A 5-d course of treatment for community-acquired pneumonia would be effective in this patient with little risk of drug interactions if the drug prescribed were:

Concerning quinupristin-dalfopristin, which statement is accurate?

Regarding the mechanism of action of aminoglycosides, the drugs

A 72-kg patient with creatinine clearance of 80 mL/min has a gram-negative infection. Amikacin is administered intra- muscularly at a dose of 5 mg/kg every 8 h, and the patient begins to respond. After 2 d, creatinine clearance declines to 40 mL/min. Assuming that no information is available about amikacin plasma levels, what would be the most reasonable approach to management of the patient at this point?

All of the following statements about the clinical uses of the aminoglycosides are accurate except:

Which statement is accurate regarding the antibacterial action of the aminoglycoside amikacin?

An adult patient (weight 80 kg) has bacteremia suspected to be due to a gram-negative rod. Tobramycin is to be administered using a once-daily dosing regimen, and the loading dose must be calculated to achieve a peak plasma level of 20 mg/L. Assume that the patient has normal renal function. Pharmacokinetic parameters of tobramycin in this patient are as follows: Vd = 30L; t1/2 = 3h; CL = 80 mL/min. What loading dose should be given?

A 76-year-old man is seen in a hospital emergency department complaining of pain in and behind the right ear. Physical examination shows edema of the external otic canal with purulent exudate and weakness of the muscles on the right side of the face. The patient informs the physician that he is a diabetic. Gram stain of the exudate from the ear shows many PMNs and gram-negative rods, and samples are sent to the microbiology laboratory for culture and drug susceptibility testing. A preliminary diagnosis is made of external otitis. At this point, which of the following is most appropriate?

Regarding the toxicity of aminoglycosides which statement is accurate?

This drug has characteristics almost identical to those of gentamicin but has much weaker activity in combination with penicillin against enterococci.

Your 23-year-old female patient is pregnant and has gonorrhea. The medical history includes anaphylaxis following exposure to amoxicillin. The most appropriate drug to use is

Which statement about “once-daily” dosing with aminoglycosides is not accurate?

A 32-year-old male presents to an outpatient clinic with a 5-day history of productive cough, purulent sputum, and shortness of breath. He is diagnosed with community- acquired pneumonia (CAP). It is noted that this patient has a severe ampicillin allergy (anaphylaxis). Which of the following would be an acceptable treatment for this patient?

A 22-year-old female presents with a 2-day history of dysuria with increased urinary frequency and urgency. A urine culture and urinalysis are done. She is diagnosed with a urinary tract infection (UTI) caused by E. coli. All of the following would be considered appropriate therapy for this patient except:

Which of the following drugs is correctly matched with the appropriate adverse effect?

Cotrimoxazole would be expected to provide coverage for all of the following organisms except:

Trimethoprim-sulfamethoxazole is established to be effective against which of the following opportunistic infections in the AIDS patient?

A 65-year-old woman has returned from a vacation abroad suffering from traveler’s diarrhea, and her problem has not responded to antidiarrheal drugs. A pathogenic gram-negative bacillus is suspected. Which drug is most likely to be effective in the treatment of this patient?

Which statement about the clinical use of sulfonamides is false?

A 31-year-old man has gonorrhea. He has no drug allergies, but a few years ago acute hemolysis followed use of an anti-malarial drug. The physician is concerned that the patient has an accompanying urethritis caused by C trachomatis, although no cultures or enzyme tests have been performed. Which of the following drugs will be reliably effective against both gonococci and C trachomatis and safe to use in this patient?

Which statement about the fluoroquinolones is accurate?

A 40-year-old man complains of periodic bouts of diarrhea with lower abdominal cramping and intermittent rectal bleeding. Seen in the clinic, he appears well nourished, with blood pressure in the normal range. Examination reveals moderate abdominal pain and tenderness. His cur- rent medications are limited to loperamide for his diarrhea. Sigmoidoscopy reveals mucosal edema, friability, and some pus. Laboratory findings include mild anemia and decreased serum albumin. Microbiologic examination via stool cultures and mucosal biopsies do not reveal any evidence for bacterial, amebic, or cytomegalovirus involvement. The most appropriate drug to use in this patient is

Which adverse effect is most common with sulfonamides?

Which drug is effective in the treatment of nocardiosis and, in combination with pyrimethamine, is prophylactic against Pneumocystis jirovecii infections in AIDS patients?

Which statement about ciprofloxacin is accurate?

Supplementary folinic acid may prevent anemia in folate- deficient persons who use this drug; it is a weak base achieving tissue levels similar to those in plasma

A woman being treated for a urinary tract infection complains of heel pain and is found to have an inflamed Achilles tendon. Bacterial resistance to the agent causing this adverse effect may result from decreased binding to which cell constituent?

A man with a staphylococcal infection is placed on a drug

that disrupts plasma membrane function. He should be monitored for which adverse effect?

A man treated for a Nocardia asteroides infection subsequently develops hemolytic anemia. Which condition would predispose the patient to this adverse effect?

A woman with traveler’s diarrhea was treated with an agent that is not absorbed from the gut. Which agent was most likely used for this condition?