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Epiglottitis Airway Priority — SCE Infectious Diseases MCQ

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HardRespiratory InfectionEpiglottitis Airway PrioritySCE Infectious Diseases

Enterococcus faecalis native-valve endocarditis is susceptible to ampicillin and vancomycin but has high-level gentamicin resistance. Renal function is moderately impaired. Which bactericidal strategy is most appropriate?

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Correct answer: E — Ampicillin or amoxicillin plus ceftriaxone for 6 weeks

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

D is correct. High-level aminoglycoside resistance abolishes the usual cell-wall-agent/aminoglycoside synergy, so gentamicin-containing options remain ineffective despite therapeutic drug monitoring. Ampicillin or amoxicillin plus ceftriaxone provides complementary penicillin-binding-protein inhibition and is the established six-week double-beta-lactam regimen for E. faecalis; it is also attractive with renal impairment. Low-dose daptomycin monotherapy is inadequate for this high-inoculum infection, and ceftriaxone alone has insufficient enterococcal activity.

Reference: ESC 2023 guideline for the management of endocarditis: https://academic.oup.com/eurheartj/article/44/39/3948/7243107