Antimicrobials USMLE Step 1 Practice Question
A 42-year-old woman with HIV infection (CD4 200 cells/μL) presents with fever, headache, and positive blood culture for Cryptococcus neoformans. Vital signs: BP 118/76, HR 102, RR 20, Temp 39.2°C, SpO2 98%. She is started on amphotericin B deoxycholate. On day 5, BUN rises from 18 to 72 mg/dL with creatinine 2.8 mg/dL; urinalysis shows no proteinuria. Which intervention would most reduce amphotericin B nephrotoxicity?
Answer choices
- AIncrease normal saline hydration before each infusion
- BAdd concurrent pentamidine for synergistic fungicidal activity
- CAdminister acetaminophen before each infusion
- DReduce the amphotericin B dose by half
- ESwitch to liposomal amphotericin B formulationCorrect answer
- FAdd concurrent fluconazole to allow earlier discontinuation of amphotericin B
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