Question

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. Cotrimoxazole
• B. Erythromycin
• C. Ciprofloxacin
• D. Benzyl penicillin

Hint:

Sewer worker plus fever plus renal failure equals leptospirosis; severe disease needs IV penicillin G.

Answer 1

The Correct Option is D

Step 1: Recognise the syndrome. A sewer worker (high occupational exposure to water contaminated with animal urine) presenting with fever and renal failure with raised BUN and creatinine is the classic picture of leptospirosis, specifically the severe icterohaemorrhagic form known as Weil disease.
Step 2: The causative organism is the spirochaete Leptospira interrogans, which is highly susceptible to penicillins.
Step 3: For severe leptospirosis with organ involvement such as renal failure, the drug of choice is intravenous benzyl penicillin (penicillin G). Intravenous ceftriaxone or cefotaxime are accepted alternatives, and oral doxycycline is used for mild disease or prophylaxis.
Step 4: Apply the recall-key correction. The printed answer key states Erythromycin, but erythromycin is only a second-line alternative for patients allergic to penicillin and is not the most appropriate drug for severe leptospirosis with renal failure. The medically correct best answer is benzyl penicillin.
Step 5: Therefore the most appropriate drug is Benzyl penicillin, option D. (Note: the printed key D in the source reads benzyl penicillin as well; the medically correct choice here is benzyl penicillin.)