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 63-year-old man with non-Hodgkin lymphoma is brought to the emergency department because of fever and confusion that have progressively worsened over the past 3 days. He also has a 3-day history of loose stools. He returned from France 2 weeks ago where he stayed in the countryside and ate typical French cuisine, including frog, snail, and various homemade cheeses. His last chemotherapy cycle was 3 weeks ago. He is oriented to person but not to place or time. His temperature is 39.5°C (103.1°F), pulse is 110/min, and blood pressure is 100/60 mm Hg. Examination shows cervical and axillary lymphadenopathy. The lungs are clear to auscultation. There is involuntary flexion of the bilateral hips and knees with passive flexion of the neck. Neurologic examination shows no focal findings. Laboratory studies show:
Hemoglobin 9.3 g/dL
Leukocyte count 3600/mm3
Platelet count 151,000/mm3
Serum
Na+ 134 mEq/L
Cl- 103 mEq/L
K+ 3.7 mEq/L
Glucose 102 mg/dL
Creatinine 1.3 mg/dL
A lumbar puncture is performed. Cerebrospinal fluid analysis shows a leukocyte count of 1200/mm3 (76% segmented neutrophils, 24% lymphocytes), a protein concentration of 113 mg/dL, and a glucose concentration of 21 mg/dL. The results of blood cultures are pending. Which of the following is the most appropriate initial pharmacotherapy?"
assistant
Vancomycin, ampicillin, and cefepime