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Pseudomonas Bronchiectasis Exacerbation — SCE Infectious Diseases MCQ

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HardRespiratory InfectionPseudomonas Bronchiectasis ExacerbationSCE Infectious Diseases

After 24 days of daptomycin, a patient develops fever, hypoxaemia, diffuse bilateral infiltrates and bronchoalveolar-lavage eosinophilia. Cultures are negative. What is the best immediate management?

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Correct answer: AStop daptomycin immediately and consider systemic corticosteroids

Explanation lettering: B = shown as A · E = shown as B · A = shown as D · D = shown as E

B is correct. This delayed febrile hypoxaemic syndrome with diffuse infiltrates and eosinophilia is classic daptomycin-associated eosinophilic pneumonia, which commonly appears after more than two weeks. The SmPC requires immediate discontinuation; systemic corticosteroids are often appropriate according to severity. It is independent of CPK, dose-spacing does not make rechallenge safe, and simply broadening antibacterial therapy delays removal of the cause. Oxygenation, organ support and an alternative agent for the original infection are addressed in parallel.

Reference: Cubicin 500 mg SmPC: https://www.medicines.org.uk/emc/product/8124/smpc