Question:hard
A sewer worker presented with fever. Lab findings revealed renal failure with increased BUN and serum creatinine. What is the most appropriate drug to give him?
A sewer worker presented with fever. Lab findings revealed renal failure with increased BUN and serum creatinine. What is the most appropriate drug to give him?
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Sewer worker plus fever plus renal failure equals leptospirosis; severe disease needs IV penicillin G.
Updated On: Jun 24, 2026
- Cotrimoxazole
- Erythromycin
- Ciprofloxacin
- Benzyl penicillin
Show Solution
The Correct Option is D
Solution and Explanation
The occupational clue is decisive. Sewer and rice-field workers wade through water polluted by rodent urine and are the textbook risk group for leptospirosis caused by the spirochaete Leptospira interrogans. The combination of fever with acute kidney injury, shown by the rising blood urea nitrogen and serum creatinine, indicates severe systemic disease, the icterohaemorrhagic Weil syndrome that also threatens the liver and lungs. Treatment is stratified by severity. Mild ambulatory disease is managed with oral doxycycline, while severe disease with organ dysfunction demands an intravenous bactericidal agent, and the first-line choice is intravenous penicillin G, that is benzyl penicillin, with third-generation cephalosporins like ceftriaxone as equivalent alternatives. Macrolides such as erythromycin or azithromycin are reserved only as substitutes when penicillin cannot be used, for example in true penicillin allergy, so erythromycin is not the most appropriate drug for this severely ill patient. Cotrimoxazole and ciprofloxacin are not standard antileptospiral agents. Matching severe leptospirosis to its drug of choice gives benzyl penicillin. \[\boxed{\text{Benzyl penicillin}}\]
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