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C.A. is a 13-year-old female adolescent (weight 56 kg) who presents to the ED with a 1-day history of fever and severe lower right quadrant pain. On examination, she is tearful and reports a pain score of 9/10. She has rebound tenderness when palpating her abdomen. Her temperature is 39.5°C. She has no significant medical history but did begin her menses 3 days ago for the first time.

Which is the best initial empiric antibiotic regimen to begin?

a. Cefazolin 1 g intravenously every 8 hours and metronidazole 500 mg intravenously every 8 hours.

b. Ampicillin 2 g intravenously every 8 hours and gentamicin 5 mg/kg/day intravenously every 24 hours.

c. Ceftriaxone 2 g intravenously every 24 hours and tobramycin 5 mg/kg/day every 24 hours.

d. Clindamycin 600 mg intravenously every 8 hours and gentamicin 5 mg/kg/day intravenously every 24 hours.

Answer :

Final answer:

The best initial empiric antibiotic regimen for a 13-year-old female adolescent presenting with symptoms of appendicitis is c)ceftriaxone 2 g intravenously every 24 hours and tobramycin 5 mg/kg/day intravenously every 24 hours. Ceftriaxone provides broad-spectrum coverage that is appropriate for the suspected bacteria in appendicitis.

Explanation:

The female adolescent presenting with a fever and severe lower right quadrant pain with a history of recent menses is likely suffering from appendicitis, considering her symptoms and the results of her clinical examination demonstrating rebound tenderness. In such a case, empiric antibiotic therapy would be initiated to cover the suspected pathogenic bacteria commonly found in appendicitis.

In this scenario, based on the provided information, options include:

  • Cefazolin and metronidazole
  • Ampicillin and gentamicin
  • Ceftriaxone and tobramycin
  • Clindamycin and gentamicin

Considering the severity of the symptoms and the need for broad coverage, ceftriaxone combined with an aminoglycoside like tobramycin (option c) would offer broad coverage, especially when there is no known allergy or contraindications to these antibiotics. Ceftriaxone is a third-generation cephalosporin, with good efficacy against a wide range of microorganisms typically involved in abdominal infections, including appendicitis. It is important to adjust the treatment as needed based on the patient's response and any further diagnostic information, such as antibiotic susceptibility testing results.

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