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Infectious Diseases


Answer 5
  1. Linezolid. Based on the patient’s clinical presentation and results of sputum testing, she likely has bacterial pneumonia caused by S. aureus. An antibiotic with MRSA coverage, such as linezolid, should be initiated for treatment of presumed staphylococcal pneumonia. Prompt treatment is important as demonstrated in 2 recent reports that found a combined mortality rate of 40% in 25 otherwise healthy patients (median age, 21 and 17.8 yr, respectively) with CA-MRSA associated with severe pneumonia following influenza-like illnesses.11,12 Ribavirin has antiviral properties and is used to treat viral pneumonia, not bacterial pneumonia. Gentamicin would not be the best choice in this setting as it is not used as monotherapy for staphylococcal infections and it only has synergistic activity against gram-positive organisms. Although levofloxacin has extended coverage for Streptococcus species, it does not have reliable activity against MRSA. Daptomycin has excellent anti-MRSA activity but does not achieve adequate concentrations in fluid obtained from the epithelial lining of the lungs because it irreversibly binds to lung surfactant.

    REFERENCE
    11. Hageman JC, Uyeki TM, Francis JS, et al. Severe community-acquired pneumonia due to Staphylococcus aureus, 2003-04 influenza season. Emerg Infect Dis 2006;12:894-9.

    12. Centers for Disease Control and Prevention (CDC). Severe methicillin-resistant Staphylococcus aureus community-acquired pneumonia associated with influenza—Louisiana and Georgia, December 2006-January 2007. MMWR Morb Mortal Wkly Rep 2007;56:325-9.

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