A 43-year-old male teacher, previously in good health, presents with 4 days of fever and a sudden onset of headache, altered consciousness, and hemiparesis. There is no obvious source of the fever, and the patient has no known risk factors such as HIV infection or intravenous drug abuse.
In the Emergency Room a CT scan and then a CT angiogram is ordered and a ruptured middle cerebral aneurysm is found which is described by the radiologist as “mycotic” based on its location and the characteristics of its wall.
Pending neurosurgical intervention and cultures, the antibiotic(s) most likely to be active against the causative organism is/are:
Fluconazole
Liposomal Amphotericin B
Vancomycin
Ciprofloxacin plus gentamicin