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An 18-year-old boy with cystic fibrosis presents to the Emergency Department with a 4-day history of progressively worsening productive cough, fever, and malaise. His temperature is 38.8°C, blood pressure is 110/75 mmHg, heart rate is 104 beats per minute, and respiratory rate is 24 breaths per minute. Chest x-ray demonstrates a right lower lobe infiltrate. Which antibiotic would be most beneficial for empiric treatment of this patient?

Question

An 18-year-old boy with cystic fibrosis presents to the Emergency Department with a 4-day history of progressively worsening productive cough, fever, and malaise. His temperature is 38.8°C, blood pressure is 110/75 mmHg, heart rate is 104 beats per minute, and respiratory rate is 24 breaths per minute. Chest x-ray demonstrates a right lower lobe infiltrate. Which antibiotic would be most beneficial for empiric treatment of this patient?

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Solution

The patient's symptoms and history of cystic fibrosis suggest a likely pulmonary exacerbation, often due to bacterial infection. The most common pathogens in cystic fibrosis are Staphylococcus aureus and Pseudomonas aeruginosa.

Given the patient's age, there is a high likelihood that Pseudomonas aeruginosa could be the causative organism. Therefore, the patient should be started on an antipseudomonal antibiotic.

A common choice would be a combination of two antipseudomonal drugs to provide broad coverage and prevent resistance. This could include a beta-lactam antibiotic such as piperacillin-tazobactam or ceftazidime, in combination with an aminoglycoside like tobramycin.

In addition, if the patient has a history of methicillin-resistant Staphylococcus aureus (MRSA), coverage with an antibiotic like vancomycin or linezolid

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