A 75-year-old patient is 48 hours status post lumbar laminectomy and develops fever, cough with purulent sputum, and leukocytosis. The most appropriate treatment is which?

• A. Await results of sputum cultures.
• B. Begin chest physiotherapy.
• C. Administer antibiotics.
• D. Administer prednisone.

Answer: (C)

When postoperative fever with productive cough and leukocytosis points to bacterial pneumonia, the priority is to start antibiotic therapy right away. Purulent sputum and elevated white count strongly suggest a bacterial infection, and delaying treatment to wait for culture results can allow the infection to progress, increasing risk of complications. Start empiric antibiotics now, while cultures are obtained to guide later narrowing or adjustment. Supportive measures like chest physiotherapy may help with secretion clearance, but do not treat the infection. Corticosteroids are not indicated for an active bacterial infection and could worsen outcomes.