In a critically ill patient with sepsis, the only effective antibiotic has a TI of 2 and known nephrotoxicity. Evaluate whether its use is justified and state what steps should be taken immediately to manage risk.

• A. Use is justified if no safer effective alternatives exist because treating the life‑threatening infection takes precedence; immediately obtain baseline renal testing, initiate therapeutic drug monitoring where possible, and plan for dose adjustment or renal support if toxicity emerges.
• B. Use is justified only if the patient is young and otherwise healthy; otherwise, always choose a less effective antibiotic to avoid nephrotoxicity regardless of infection severity.
• C. Use is justified but monitoring is unnecessary because organ dysfunction in critically ill patients masks any additional drug-induced nephrotoxicity, so no action can mitigate risk.
• D. Use is never justified because a TI of 2 indicates unacceptable risk; withhold antibiotic and provide supportive care only until the infection resolves spontaneously.

Answer: (A)