Brittany

This case study is noted with a 68-year-old male being treated in the medical ward for community acquired pneumonia for the past 3 days. Residents height is 5’8 and weight is 89 kg. This patient is noted with a PMH of COPD, HTN, HLD, and DM. His empiric antibiotic started was ceftriaxone 1 gram and azithromycin 500mg IV every day for 3 days. Resident has an allergy to penicillin and has clinically improved not requiring as much oxygen. Resident is having some GI upset such as nausea and vomiting that is also affecting resident being able to tolerate meals. Zofran 4mg may be administered to help with nausea for meals. Blood glucose should be monitored due to risk of hyperglycemia.  

First thing to discuss is where exactly the pneumonia was acquired which it states community. Different bacteria are present with the different forms of pneumonia. First off, I would look to see if the antibiotic that I was administering was effective to that specific bacteria that was collected prior to antibiotic administration (Rosenthal & Burchum, 2021). The current regimen is effective in treating community acquired pneumonia. But while reviewing this residents’ comorbidities he does have cardiopulmonary considerations to look at. This patient maybe a better fit for a respiratory fluroquinolone, or a beta-lactam antibiotic plus a macrolide (Watkin & Lemonovich, 2011).   Due to the patient having a penicillin allergy I would have to look at the noted reaction the patient has to Penicillin and see what antibiotic would be appropriate for the patient. With him having a reaction of a rash to penicillin empiric antibiotic selection would be used (File, 2020). It notes that a third or fourth generation cephalosporin would be safe for resident use. Cephalosporins destroy bacteria by destroying the bacteria wall (Rosenthal & Burchum, 2021).

 I would also suggest a that the patient starts on a probiotic to decrease the chances of c-diff due to the changes of gut flora with the administration of antibiotics. Since the patient has shown improvement in within three days IV antibiotics should be changed to Po route if patient can tolerate (Watkin & Lemonovich, 2011 ). My final medication regimen for this individual would be cephalosporin like cefdinir and macrolide such as the azithromycin. Education on completion and adherence to antibiotic therapy is also an important factor and treatment of this patient.

Reference

File, T. M. (2020, December 28). Treatment of community-aquired pneumonia in adults who require hospitalization. Retrieved January 26, 2021, from HTTPS:// www.uptodate.com/contents/treatment-of-community-aquired-pneumonia-in-adults-who-require-hospitlization#H2224178418

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Watkin, R.R., & Lemonovich, T. L., (2011, June 1). Diagnosis and management of community acquired pneumonia in adults. Retrieved January 26, 2021, from HTTPS://www.aafp.org/afp/2011/0601/p1299.html

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