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.
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