American Board of Internal Medicine (ABIM) Certification Practice Exam

If an individual has severe illness due to Salmonella, which combination of medications may be utilized?

1. Amoxicillin plus parenteral third-generation cephalosporin

2. Fluoroquinolone plus parenteral third-generation cephalosporin

3. Azithromycin plus oral rehydration solution

4. Tetracycline plus metronidazole

The correct answer is: Fluoroquinolone plus parenteral third-generation cephalosporin

In cases of severe Salmonella infection, fluoroquinolones and parenteral third-generation cephalosporins are often recommended due to their effective coverage against the organism and ability to penetrate tissues and abscesses if needed. Fluoroquinolones, such as ciprofloxacin, are particularly effective against many strains of Salmonella and can rapidly reduce bacterial load, which is critical in severe infections that may lead to complications such as septicemia. Parenteral third-generation cephalosporins, like ceftriaxone or cefotaxime, enhance coverage and can also address any potential complications arising from a severe infection, including those from other bacteria that may cause similar symptoms. This combination is beneficial in treating severe cases where the risk of systemic spread or bacteremia is higher, providing both broad-spectrum coverage and reliability in terms of achieving therapeutic levels in critical settings. In contrast, other options may not provide adequate coverage or may be outdated strategies for treating severe Salmonella-related illness.