system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
A 60-year-old woman presents to the physician with a 2-day history of fever and painful swelling of the left knee. She was diagnosed with rheumatoid arthritis about 15 years ago and has a 7-year history of diabetes mellitus. Over the past year, she has been admitted to the hospital twice for acute, painful swelling of the knees and hands. She is on insulin therapy and takes methotrexate, metformin, aspirin, and prednisolone 5 mg/day. Her temperature is 38.5°C (101.3°F), pulse is 86/min, respirations are 14/min, and blood pressure is 125/70 mm Hg. A finger-stick glucose test shows 230 mg/dL. Her left knee is diffusely swollen, warm, and painful on both active and passive motion. There is evidence of deformity in several small joints of the hands and feet without any acute swelling or pain. Physical examination of the lungs, abdomen, and perineum shows no abnormalities. The synovial fluid analysis shows the following:
Color turbid, purulent, gray
Viscosity reduced
WBC 25,000/µL–250,000/µL
Neutrophils > 90%
Crystals may be present (presence indicates coexistence, but does not rule out infection)
Which of the following is the most appropriate initial pharmacotherapy in this patient?
assistant
Intravenous vancomycin