A 26-year-old male is transferred to
your ward from the short stay unit of the accident and emergency department
because of an ongoing pyrexia. He was initially admitted having become
unconscious following an alcoholic binge. He had been brought in covered in
vomitus but had no haematemesis.
On examination he was conscious and
alert. Body temperature 39 ēCelsius, pulse rate 120 beats per minute respiratory
rate 32 breaths per minute. His trachea was in the midline, respiratory
movements were diminished on the right side of his chest, percussion note was
dull in the right mid zone anteriorly and over this area the breath sounds were
amphoric in nature. In this area there were fine crepitations, vocal fremitus
and vocal resonance were increased and there was whispering pectoriloquy.
In this patient which of the following
antibiotic regimes would you use?
The history of loss of consciousness
and vomiting should immediately make one think of aspiration pneumonia. The
physical signs suggest there is cavitation in the right lung
Treatment of aspiration pneumonia is
with broad-spectrum antibiotics including cover for anaerobic organism. Hence
the combination of a cephalosporin with metronidazole would be the best of the
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