Match each clinical exposure or presentation with the most appropriate empiric antimicrobial therapy or post-exposure prophylaxis.
- A healthcare worker who performed an endotracheal intubation without a face mask on a patient with purpura fulminans and Gram-negative diplococci in the cerebrospinal fluid.Oral rifampin for 2 days
- An adolescent who develops localized erythema and purulent drainage from the plantar foot two days after stepping on a rusty nail through a rubber-soled athletic shoe.Oral ciprofloxacin
- A hiker in an endemic region who removes an engorged Ixodes scapularis tick that was attached to the skin for approximately 48 hours.Single-dose oral doxycycline
- A veterinary technician with rapid-onset erythema, pain, and swelling of the hand following a deep puncture wound from a cat bite.Oral amoxicillin-clavulanate
Answer
The healthcare worker requires rifampin for Neisseria meningitidis prophylaxis; the adolescent requires ciprofloxacin for Pseudomonas coverage; the hiker requires single-dose doxycycline for Lyme disease prophylaxis; and the veterinary technician requires amoxicillin-clavulanate for Pasteurella coverage.
Each specific exposure carries a distinct bacterial risk profile. Neisseria meningitidis droplet exposure requires nasopharyngeal eradication with agents like rifampin. Rubber-shoe punctures risk Pseudomonas aeruginosa inoculation, requiring ciprofloxacin. Prolonged Ixodes tick attachment meets criteria for Lyme prophylaxis with single-dose doxycycline. Cat bites reliably inoculate Pasteurella multocida, requiring amoxicillin-clavulanate.
Step-by-Step Solution
Key Concept
Empiric antimicrobial selection based on highly specific high-risk environmental or zoonotic exposures.