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Recurrent VVC Investigation — SCE Infectious Diseases MCQ

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HardSTIsRecurrent VVC InvestigationSCE Infectious Diseases

CSF culture from a 67-year-old receiving adalimumab grows Listeria monocytogenes. She has already improved on empirical ceftriaxone plus amoxicillin. Which definitive regimen best follows NICE NG240?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Intravenous amoxicillin or ampicillin for 21 days, with adjunctive intravenous co-trimoxazole for the first 7 days where indicated

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

E is correct. NICE specifies intravenous amoxicillin or ampicillin for 21 days for Listeria meningitis and advises specialist discussion of adjunctive intravenous co-trimoxazole for the first seven days. A is too short and substitutes gentamicin for the NICE adjunct. B uses a broader agent and reverses the adjunctive sequence. C introduces an unsupported early oral step-down. D makes co-trimoxazole monotherapy the default and delays the recommended beta-lactam. Immunosuppression is a classic Listeria risk factor and reinforces the need for a full specialist-directed CNS course.

Reference: NICE NG240: bacterial meningitis recommendations: https://www.nice.org.uk/guidance/ng240/chapter/Recommendations