American Board of Internal Medicine (ABIM) Certification Practice Exam

For which of the following conditions is vancomycin indicated in neutropenic fever?

1. Fever alone

2. Severe sepsis

3. Dehydration

4. Allergic reactions

The correct answer is: Severe sepsis

Vancomycin is indicated in the setting of neutropenic fever particularly when there is a concern for severe sepsis. Neutropenic patients, especially those undergoing cancer treatments, are at a significantly increased risk for infections due to their compromised immune systems. In such cases, the presence of fever necessitates a prompt and aggressive evaluation to identify and treat potential infections. When severe sepsis is suspected or identified in these patients, vancomycin is an important component of empiric broad-spectrum antibiotic therapy. This is primarily due to its effectiveness against gram-positive organisms, including methicillin-resistant Staphylococcus aureus (MRSA) and Streptococcus pneumoniae, which can cause serious infections in immunocompromised individuals. In contrast, conditions such as fever alone, dehydration, and allergic reactions do not specifically warrant vancomycin use. While fever itself is a common occurrence in neutropenic patients, it does not constitute an indication for vancomycin without signs of infection. Dehydration is more related to volume status and may require fluid resuscitation rather than antibiotic treatment, and allergic reactions would require different management strategies rather than antibacterial therapy. Thus, recognizing the severity of sepsis in neutropenic patients underscores the necessity of