response

Pls. respond to this separately with two references #1D

In the case study assigned for this week’s discussion, HH, a 68-year old make has been admitted for community-acquired pneumonia for the past three days. His past medical history is significant for COPD, diabetes, hypertension, and hyperlipidemia. HH remains on empiric antibiotics (Ceftriaxone), Rocephin 1mg IV QD day three, and Azithromycin (Zithromax) 500mg IV QD day 3. Since the patient’s admission, his clinical status has significantly improved with decreased oxygen requirements. However, he is not currently tolerating a diet and complains of vomiting and nausea. In addition, he has an allergy to penicillin allergy with a rash as the reaction.

The primary health need for the patient, in this case, is the elimination of his infection and control of symptoms like vomiting and nausea. These needs are a result of his CAP infection. Therefore, when selecting the antimicrobial therapy relevant to the patient, one must identify the microbes responsible for the infection (Ahdal et al., 2019). Some of the common causes include S. pneumonia, mycoplasma spp, staphylococcus aureus, and H. influenza (Koivula, 2020). The drug of choice for S. pneumonia, Mycoplasma spp, and Staphylococcus aureus is Azithromycin (Zithromax). On the other hand, Ceftriaxone is the recommended drug for H. influenza.  

A wide array of antibiotics would be recommended for this patient. However, one would take into consideration the patient’s allergy to penicillin. Given the information provided, I recommend continuing current antimicrobial treatment while assessing for any reaction with Ceftriaxone (Rocephin). Cephalosporin could have a cross-sensitivity if the patient has a penicillin allergy.

The recommended Azithromycin (Zithromax) dosage is 500mg IV Q24 times two doses and then 500mg PO QD 7-10 days (Ahdal et al., 2019). The antimicrobial treatment currently provided to the patient could address most of the common causes of CAP. Another important reason for continuing the treatment is that it has improved the patient’s clinical status through decreased oxygen requirement (Lam, 2019).

Patient education is an essential aspect of general care for this patient. Therefore, I would educate this patient on the importance of staying up to date with pneumococcal and yearly influenza vaccines, completing his antibiotic therapy as directed, and following up with his PCP once discharged (Lam, 2019). In addition, I would recommend controlling with Ondansetron (Zofran) 4mg Q6 PRN to address nausea and vomiting.

References

Ahdal, J., Nayar, S., Hasan, A., Waghray, P., Ramananthan, S., & Jain, R. (2019). Management of community-acquired bacterial pneumonia in adults: Limitations of current antibiotics and future therapies. Lung India, 36(6), 525. https://doi.org/10.4103/lungindia.lungindia_38_19

Koivula, I. H. (2020). Epidemiology of community-acquired pneumonia. Community-Acquired Pneumonia, 13-27. https://doi.org/10.1007/0-306-46834-4_2

Lam, K. W. (2019). Surveillance of community-acquired pneumonia in critically ill patients. Journal of Emergency and Critical Care Medicine, 3, 1-1. https://doi.org/10.21037/jeccm.2018.12.06

Pls. respond to this separately with two references #2

The patient in my case study is a 68-year-old male, who is admitted to the medical ward with community-acquired pneumonia (CAP) for the past three days and has comorbidities included COPD, HTN, hyperlipidemia and diabetes. The patient is on empiric antibiotics which are ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3). The patient clinical status has improved since admission with decreased oxygen need, but he is not tolerating a diet at this time with complaints of nausea and vomiting. The type of treatment regimen I would recommend for treating this patient would be to first continue the current treatment plan since the patient is experiencing improvement. Further treatment and management regimen will include identifying the causative organism and the specific antibiotic therapy should be started. According to Rider & Frazee (2018) antibiotic therapy for community-acquired pneumonia (CAP) should be targeted at the most common pathogens with consideration of local resistance patterns and patient disposition such as coexisting illness or if the patient has recently used antibiotics (Rider & Frazee, 2018). Because the patient has these comorbidities, the patient is at risk for drug-resistant Streptococcus pneumonia (Rider & Frazee, 2018). It is recommended to use a respiratory fluoroquinolone (moxifloxacin, levofloxacin), a beta-lactam (amoxicillin) plus macrolide (Rider & Frazee, 2018). This patient has diabetes mellitus which could be the causative agent, specifically Klebsiella pneumonia (Saibal et al., 2013). According to Saibal et al. (2013) “Klebsiella pneumoniae was the most frequent causative pathogen for CAP in diabetic patients, whereas Streptococcus pneumoniae was the most frequent causative agent for non-diabetic patients” (Saibal et al., 2013). Saibal et al. (2013) states that the bacteria isolated from the sputum sample of diabetic patients with CAP were resistant to almost all recommended antibiotics used for CAP but 100% of isolates were sensitive to Carbapenems (Saibal et al., 2013). The treatment regimen would also recommend obtaining a sputum gram stain, urinary antigen test and PCR as well as a urinary antigen test to identify the best specific antibiotic therapy (Restrepo et al., 2018). Patient education is very important, and the patient should be educated on the risk of spreading illness and ways to prevent the spread of community-acquired pneumonia (Pletz et al., 2016). The patient needs to understand that he is at higher risk because he has these comorbidities (Pletz et al., 2016).

References

Pletz, M. W., Rohde, G. G., Welte, T., Kolditz, M., & Ott, S. (2016). Advances in the prevention, management, and treatment of community-acquired pneumonia. F1000Research, 5, 300. https://doi.org/10.12688/f1000research.7657.1

Restrepo, M. I., Sibila, O., & Anzueto, A. (2018). Pneumonia in Patients with Chronic Obstructive Pulmonary Disease. Barcelona Respiratory Network, 4(2). https://doi.org/10.23866/brnrev:2017–0004

Rider, A. C., & Frazee, B. W. (2018). Community-Acquired Pneumonia. Emergency Medicine Clinics of North America, 36(4), 665–683. https://doi.org/10.1016/j.emc.2018.07.001

Saibal, M., Rahman, S., Nishat, L., Sikder, N., Begum, S., Islam, M., & Uddin, K. (2013). Community acquired pneumonia in diabetic and non-diabetic hospitalized patients: presentation, causative pathogens and outcome. Bangladesh Medical Research Council Bulletin, 38(3), 98–103. https://doi.org/10.3329/bmrcb.v38i3.14336