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Melioidosis Pneumonia — RACP Adult Medicine MCQ

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HardInfectious DiseasesMelioidosis PneumoniaRACP Adult Medicine

A 48-year-old man from Far North Queensland presents with high-severity CAP and septic shock. CT shows a large right upper lobe abscess. Gram stain of sputum shows gram-negative bacilli. He has type 2 diabetes. Burkholderia pseudomallei is suspected. What is the most appropriate empirical antibiotic?

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Correct answer: A — Meropenem IV

Suspected melioidosis (tropical Australia, diabetes, upper-lobe cavitating pneumonia, gram-negative bacilli) requires meropenem IV as initial intensive-phase therapy for ≥2 weeks (or until clinical improvement). B. pseudomallei is intrinsically resistant to ceftriaxone and aminoglycosides. Eradication phase is TMP-SMX oral for ≥3 months.

Reference: eTG Antibiotic – 2025 – Melioidosis; Darwin Melioidosis Study Group 2024