A 2-year-old girl is brought to the office by her mother for evaluation of
fever. You have been the girl's physician since birth. While in the office,
the girl stiffens and then has bilateral, symmetrical shaking of her upper
and lower extremities; she becomes mildly cyanotic. The episode lasts
for approximately 45 seconds, after which she becomes relaxed and
appears to fall asleep. Vital signs at this time are temperature 40.0°C
(104.0°F), pulse 120/min, and respirations 40/min. On physical
examination she has a generally pink complexion and flushed cheeks.
She is limp and somnolent and responds with a cry to noxious stimulus.
Tympanic membranes are inflamed bilaterally, nose has a scant, clear
discharge, and throat is mildly erythematous. Lungs are clear to
auscultation except for transmitted upper airway sounds. Heart has
rapid rate with a grade 1/6 systolic murmur at the left sternal border.
Complete blood count, blood culture, lumbar puncture, and
catheterized urine specimen are obtained and sent for stat analysis.
Acetaminophen is administered by rectal suppository. Thirty minutes
later the patient awakens and is smiling. She is afebrile. Additional
history discloses that she was born at term, she had an uneventful
neonatal course, she has normal growth and development, and
vaccinations are up-to-date. She has never had an episode similar to
this. Initial laboratory results are shown: Blood WBC 10,400/mm3
Neutrophils, segmented 25% Neutrophils, bands 5% Lymphocytes 65%
Monocytes 5% Cerebrospinal fluid 0 RBC/mm3 Urinalysis Normal Other
laboratory studies are pending.
In addition to ampicillin for otitis media and acetaminophen, this child
also should receive which of the following?
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