Case Study
HH is a 68-year-old male who has been admitted to the medical ward with community-acquired pneumonia. His past medical history includes COPD, HTN, hyperlipidemia, and diabetes. Currently, he is on empiric antibiotics, specifically ceftriaxone 1 g IV qd (day 3) and azithromycin 500 mg IV qd (day 3). His clinical status has improved since admission, with decreased oxygen requirements. However, he is experiencing difficulties tolerating a diet, with complaints of nausea and vomiting.
Treatment Regimen
I would recommend continuing the current empiric antibiotic therapy with Rocephin and Zithromax. Rocephin is a broad-spectrum antibiotic that covers a wide range of bacteria commonly associated with community-acquired pneumonia. On the other hand, Zithromax is effective against atypical pathogens such as Mycoplasma pneumoniae and Legionella pneumophila. Optimal antimicrobial therapy requires the identification of the infecting organism and the determination of its drug sensitivity. However, when the patient has a severe infection, we may have to initiate treatment before the lab test results are available. Drug selection must be based on clinical evaluation and knowledge of which microbes are most likely to cause infection at a particular site. A broad-spectrum agent can be used for the initial treatment. After the identity and drug sensitivity of the infecting organism has been determined, you switch to a more selective antibiotic (Rosenthal & Burchum, 2021). The combination of these antibiotics provides coverage against typical and atypical pathogens, which is essential in managing community-acquired pneumonia. In addition to antibiotics, supportive care should also be provided. This includes ensuring adequate oxygenation, monitoring vital signs, and managing symptoms such as nausea and vomiting. Antiemetic medications, such as Zofran, may be considered to alleviate HH’s symptoms and improve his tolerance to a diet. Increasing early detection and treatment strategies are crucial to improving patient outcomes (Aston, 2019).
Education Strategy
Providing HH with information on the importance of completing the entire course of antibiotics as prescribed is essential. This will help get rid of the infection and prevent the development of antibiotic resistance. So many patients stop their antibiotics when they start feeling better. “Stopping antibiotics early, rather than completing pre-set antibiotic courses, may help reduce unnecessary exposure to antibiotics and antimicrobial resistance (AMR)” (Borek et al., 2021, pg.1). This is always a vital education strategy to mention when discussing antibiotics with patients. It is also crucial to educate HH on the potential side effects of the medications, such as gastrointestinal upset, and provide strategies to manage these side effects. For example, he can be advised to take antibiotics with food to minimize gastrointestinal discomfort. HH should also be educated on the importance of maintaining good hygiene, such as covering his mouth and nose when coughing or sneezing, to prevent the spread of infection to others. Encouragement should be provided to follow up with his healthcare provider for further evaluation and monitoring of his condition.
References
Aston, S. J., Ho, A., Jary, H., Huwa, J., Mitchell, T., Ibitoye, S., … & Gordon, S. B. (2019). Etiology and risk factors for mortality in an adult community-acquired pneumonia cohort in Malawi. American Journal of Respiratory and Critical Care Medicine, 200(3), 359-369.
Borek, A. J., Edwards, G., Santillo, M., Wanat, M., Glogowska, M., Butler, C. C., … & Tonkin-Crine, S. (2023). Re-examining advice to complete antibiotic courses: a qualitative study with clinicians and patients. BJGP open.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier
