Sun28November0440PM 45

A 68-year-old male patient presents with cough, fever and haemoptysis. He symptoms are failing to respond to a course of oral antibiotics prescribed by the GP, he is presently on day 3 of intravenous antibiotics from the outpatient antibiotics team (OPAT).

He is pyrexial 38°C and examination of the chest reveals bronchial breathing in the left upper lobe. Significant history includes chronic kidney disease (GFR 40 ml/hr) and chemotherapy for multiple myeloma.

You request a CT chest which reveals a cavitating lesion in the left upper lobe.

Which of the following would be the most appropriate treatment in this patient?

(Please select 1 option)

Amoxicillin and metronidazole

Amphotericin

Fluconazole

Anti-tuberculous therapy Incorrect answer selected

Voriconazole This is the correct answer

Explanation

This patient is likely to be immunocompromised and so at risk of developing fungal infection. His presentation is in keeping with this.

The CT confirms the diagnosis and treatment of choice would be with voriconazole.

Amphotericin is to be used cautiously in renal failure and fluconazole would be insufficient in this case.

Answer Statistics

1

11%

2

19%

3

7%

4

36%

5

29%

Times answered: 322