Infectious Diseases II

antiretroviral therapy because of nonadherence. The

patient requires intubation and is receiving 40%

fraction of inspired oxygen (Fio2). His relevant labo-

ratory values are as follows: SCr 1.0 mg/dL, CD4+

count 100/mm3, lactate dehydrogenase (LDH) 550

IU/L, partial pressure of arterial oxygen (PaO2) 80

mm Hg, partial pressure of arterial carbon dioxide

(PaCO2) 40 mm Hg, and white blood cell count

(WBC) 4 x 103 cells/mm3. The patient has a sulfa

allergy and a glucose-6-phosphate dehydrogenase

deficiency. In addition to adjunctive corticosteroids,

which regimen for presumed Pneumocystis jiroveci

pneumonia is most appropriate?

intravenously, divided every 6 hours.

hours alone.

clindamycin 600 mg intravenously every 8

hours alone.

A 50-year-old woman with acute myeloid leuke-

mia is admitted for induction therapy. During the

patient’s clinical course, she develops respiratory

distress, for which she is admitted to the medical

ICU. She is found to have neutropenic fever and is

empirically treated with meropenem plus gentami-

cin plus vancomycin. On day 5 of empiric therapy,

blood cultures are growing pan-susceptible E. coli.

The patient’s relevant laboratory values and vital

signs are as follows: blood pressure 115/70 mm

Hg, heart rate 84 beats/minute, temperature 101.2°F

(38.4°C), and absolute neutrophil count less than 50

cells/mm3. Which is the most appropriate antimicro-

bial regimen for the patient?

mycin for 14 days.

initiate ampicillin intravenously to treat until

neutrophils recover.

nem and gentamicin until neutrophil recovery.

microbials for 14 days.