Correct!
1. Admit and treat with piperacillin/tazobactam and doxycycline

The chest x-ray shows a right upper lobe consolidation which is compatible with CAP. A variety of protocols have been devised for determining admission for CAP. These include CURB-65 criteria (2). CURB-65 stands for Confusion; Blood Urea nitrogen greater than 7 mmol/L (19 mg/dL); Respiratory rate of 30 breaths per minute or greater; Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less; and age 65 or older. Each is given a point and those with 2 or more points should be admitted to the hospital.
The patient was admitted and treated with piperacillin/tazobactam and doxycycline but did not improve over the next several days with increased requirement for supplemental oxygen. A repeat chest x-ray showed worsening RUL consolidation (Figure 2).

Figure 2. Repeat chest x-ray 3 days after admission.

What should be done at this time? (Click on the correct answer to be directed to the fifth of seven pages)

  1. Bronchoscopy with bronchoalveolar lavage
  2. Broaden the antibiotic coverage
  3. Empirically begin fluconazole
  4. 1 and 3
  5. All of the above

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