Answers

1. D. Doxycycline is the preferred parenteral tetracy-cline for the primary state of Lyme disease in adults and children older than 8 years of age. Penicillin V (A) would be ineffective. Erythromycin (B) and clarithromycin (C) also are not effective against Borrelia burgdorferi, the gram-negative anaerobe organism responsible for Lyme disease.

2. E. Chloramphenicol is no longer the treatment of choice for any bacterial infection because of the potentially fatal chloramphenicol-induced bone marrow suppression. In the past it has been used against the infections indicated in choices A, B, C, and D. It remains a major treatment for typhoid and paratyphoid fever in some developing countries, since alternative drugs are much more expensive.

3. D. Clarithromycin is one of the recommended antimicrobials for use in combination with other antimicrobials in treating disseminated Mycobacterium avium complex.

4. D. Although ciprofloxacin is the primary agent recommended for prophylaxis against anthrax, doxycy-cline is an equally effective agent. Amoxicillin (A) is not as effective. The macrolides (B) and (C) also are not as effective. Clindamycin (E) is not indicated for this use.

5. B. This individual most likely has a group A streptococcal infection due to a minor wound. Now it appears he is developing necrotizing fascitis, a serious complication. Sometimes when a large amount of group A streptococcal organisms are present, penicillin is not effective. Clindamycin is usually very active against streptococcal infections because the size of the bacterial inoculum will not affect its efficacy. Actually, the treatment of choice for this condition is immediate and possibly repeated surgical de-bridement of the involved area. Antibiotics are supportive therapy.

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