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Melioidosis — DTM&H MCQ

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HardTropical bacterial infectionsMelioidosisDTM&H

A man with diabetes has culture-confirmed melioidosis, septic shock, multilobar pneumonia and splenic abscesses. He is admitted to intensive care. Which antimicrobial sequence is most appropriate?

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Correct answer: E — Intravenous meropenem, followed by prolonged oral co-trimoxazole eradication therapy

The best answer is “Intravenous meropenem, followed by prolonged oral co-trimoxazole eradication therapy”. Severe ICU melioidosis is treated with a parenteral intensive phase; contemporary Darwin guidance reserves meropenem for this severity. A prolonged oral eradication phase, preferably co-trimoxazole when tolerated, reduces relapse. Aminoglycosides, ceftriaxone, short doxycycline monotherapy and an oral-only start are not equivalent regimens for septic shock.

Reference: UKHSA: management of melioidosis: https://researchportal.ukhsa.gov.uk/en/publications/management-of-melioidosis/; 2020 review and revision of the Darwin melioidosis treatment guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC7544138/