Question

A patient has nasal congestion, green mucus, facial pressure, and a history of penicillin allergy. What is the likely diagnosis, and how should it be managed?

a) Allergic rhinitis; prescribe antihistamines
b) Sinusitis; prescribe amoxicillin-clavulanate
c) Pharyngitis; prescribe penicillin with close monitoring
d) Influenza; recommend rest and hydration

Answer 1

The patient with nasal congestion, green mucus, facial pressure, and a penicillin allergy likely has bacterial rhinosinusitis. The management should avoid penicillin derivatives due to the allergy, and azithromycin is a suitable alternative.

Step-by-step explanation:

The patient's symptoms of nasal congestion, green mucus, facial pressure, and history of penicillin allergy suggest a likely diagnosis of bacterial rhinosinusitis. The appropriate management, considering the penicillin allergy, would not include amoxicillin-clavulanate, as it is a penicillin derivative. Instead, an antibiotic from a different class, such as a macrolide, could be used. An example is azithromycin, which targets bacterial ribosomes. This choice would avoid the allergy concern and still provide effective treatment against common pathogens that cause rhinosinusitis, such as S. pneumoniae, H. influenzae, and M. catarrhalis.