Purulent meningitis
52-years old man (70 kg) has been delivered to emergency completely deteriorated and in delirium. The body temperature has been increased for more than 24 hours; he complained already earlier for strong headache, nausea, and he was vomiting repeatedly. By lumbal punction, increased opening pressure was confirmed; increased protein levels, decrease glucose level and increased number of neutrophils was observed. After Gram`s staining of cerebrospinal fluid, presence of gram-positive diplococci was confirmed and purulent meningitis was set as preliminary diagnosis.
Based on microbiological reports, in approximately 15 % of isolated Str. pneumoniae in community the MIC for penicillin G is 20 microgram/ml.
Questions
1. What does it mean for the therapy, if the MIC is at this level?
2. List general mechanisms of antibiotics resistance and choose the one which is the molecular base for resistance of pneumococci to penicillin G.
3. The therapy of this patient must immediately begin with intravenous administration of (choose the most correct answer and explain your decision):
a) amoxicillin
b) ampicillin with sulbactam
c) cefotaxime with vancomycine
d) cefoxitin
e) nafcillin
4. If our patient is 82 year old and after the liquor staining gram-positive diphteroid rods are present, the empirical therapy would include (choose the most correct answer and explain your decision):
a) ampicillin
b) cefazolin
c) ertapenem
d) fosfomycin
e) vancomycin