In acute chest syndrome in sickle cell disease, which antibiotic coverage is recommended?

• A. Third-generation cephalosporin with azithromycin
• B. Narrow-spectrum penicillin only
• C. Vancomycin alone
• D. Amoxicillin

Answer: (A)

Acute chest syndrome in sickle cell disease is treated empirically as a pneumonia-like illness, so the antibiotic plan must cover both typical respiratory pathogens and atypical bacteria that aren’t killed by beta-lactams alone. A third-generation cephalosporin provides strong IV coverage against common typical pathogens such as Streptococcus pneumoniae and Haemophilus influenzae. Adding a macrolide like azithromycin extends coverage to atypical organisms such as Mycoplasma and Chlamydophila, which are common in ACS presentations and would be missed by many beta-lactams alone. This combination therefore offers comprehensive initial coverage for hospitalized patients with ACS.

Narrow-spectrum penicillin alone wouldn’t cover atypicals; vancomycin alone misses many Gram-negative and atypical pathogens; and amoxicillin lacks adequate coverage for Haemophilus influenzae and resistant pneumococci and is not appropriate as initial IV therapy for ACS.