HH is a 68 yo M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet at this time with complaints of nausea and vomiting.
Ht: 5’8” Wt: 89 kg Allergies: Penicillin (rash)
Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.
MODULE 7: Women’s and Men’s Health, Infections, and Hematologic Systems, Week 9 and 10 Discussion
CASE STUDY 1
HH is a 68 yo M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet at this time with complaints of nausea and vomiting.
Ht: 5’8” Wt: 89 kg Allergies: Penicillin (rash)
Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.
Week 9 Discussion
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Week 9 Discussion Post
Patient HHH is 68-year-old male admitted for a diagnosis of community-acquired pneumonia. He has a past medical history of COPD, HTN, HLD, and DM. Patient HH is receiving ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3). Overall, his clinical status has improved since admission. There are non-reactive results on the urine legionella and pneumococcal antigen. Chest x-ray shows right lower lobe infiltrates and bronchial alveolar lavage culture was positive for gram-positive cocci in pairs with a WBC of 34 and heavy growth for streptococcus pneumoniae. After initiating treatment, HH’s vital signs have stabilized, WBC had decrease, electrolyte and complete blood count are within normal limits and oxygen saturation is increasing on room air. However, he is not tolerating a diet and has complaints of nausea and vomiting. The antibiotic minimum inhibitory concentration interpretation shows that penicillin, ceftriaxone, vancomycin and levofloxacin are susceptible drugs used to treat the bacterial infection however erythromycin and tetracycline were resistant to the bacteria.
Patient HH is susceptible to being diagnosed with community-acquired pneumonia (CAP) because he has various risk factors for the disease. Having a history of diabetes, COPD and being over the age of 65, puts this patient at a higher risk of contracting pneumonia. Since the patient’s clinical status is improving as evidence by a decrease in white blood cell count and improvement in pulse oximetry, I would recommend that the patient continue his antibiotic treatment. The overall goals of medical treatment for patients diagnosed with CAP is to resolve symptoms and to prevent reinfection (Lutfiyya, Henley & Chang, 2006). For patients receiving management for CAP while hospitalized, one of the preferred treatments is the administration of intravenous cefotaxime or ceftriaxone in addition to a macrolide antibiotic (Lutifyya, Henly & Chang, 2006). Thus, the patient’s symptoms improved after receiving the preferred treatment for CAP. However, patient HH is experiencing of vomiting and nausea and is unable to tolerate food. It is more than likely that patient HH is experiencing side effects from the antibiotic therapy. One explanation for the patient’s symptoms is that there can be an underlying cause to why the patient is nauseous and vomiting. Practitioners need to perform different diagnostic tests such as an MRI, CT scan or endoscopy to determine if something is causing the symptoms. Once diagnostic testing confirms that there is no physiological cause for symptoms, there could be another possible explanation to why the patient is nauseous and vomiting.
A common side effect of empiric antibiotics is gastrointestinal upset such as nausea, vomiting and diarrhea (Zagaria, 2013). These side effects should typically pass once the antibiotic treatment is completed (NHS, 2019). I would not be concerned with toxicity related to antibiotic use in older adults in this circumstance. According to Rosenthal and Burchum, the geriatric population is susceptible to heightened drug sensitivity due to reduced drug metabolism and excretion which may result in higher plasma drug concentrations and toxicity (2018). Common toxicity symptoms are neurological symptoms such as dizziness, confusion or seizures, renal dysfunction, hyperkalemia and liver impairment (Samai, 2013). Since the patient did not display nor report any neurological status decline and serum potassium level remained within normal limits, it would be logical to conclude that patient HH is not experiencing a toxic level of the medication. Penicillin is another option for the treatment of streptococcus pneumoniae however the patient has an allergy to penicillin (Rosenthal & Burchum, 2018). On the contrary, if the patient is still experiencing nausea and vomiting with the prescribed medications, the patient can be switched to another antibiotic therapy. Moxifloxacin, a classification of quinolone antibiotics, has shown to be safe and efficient in treating community-acquired pneumoniae and has no interference with the patient’s penicillin allergy (Kuzman, 2014). Patient should be instructed to take Moxifloxacin 400 mg IV or PO (once patient tolerated diet) q daily for 7-14-day course depending on the severity of the infection (Kuzman, 2014).
Education is key when it comes to effective pharmacological treatment. The practitioner should be advised that when selecting drugs to treat the patient’s condition, one must weigh the benefits and risks of treatment. The benefit of fighting infection outweighs the risk of developing nausea and vomiting. It would probably be beneficial to prescribe an antiemetic or proton pump inhibitor (i.e., Reglan or Protonix) or instruct the patient to take medications with food instead of on an empty stomach to prevent GI upset. Once the vomiting and nausea was resolved, then the patient could be transitioned to oral antibiotics. Oral antibiotic treatment is typically started after 2-3 days following intravenous administration of a drug (Cyriac & James, 2014). Patient HH should be educated on the importance of completing the full course of antibiotics in order to receive the most effective treatment (Rosenthal & Burchum, 2018).
References:
Cyriac, J. M., & James, E. (2014). Switch over from intravenous to oral therapy: A concise overview. Journal of pharmacology & pharmacotherapeutics, 5(2), 83–87. doi:10.4103/0976-500X.130042
Kuzman, I., Bezlepko, A., Kondova Topuzovska, I., Rókusz, L., Iudina, L., Marschall, H. P., & Petri, T. (2014). Efficacy and safety of moxifloxacin in community acquired pneumonia: a prospective, multicenter, observational study (CAPRIVI). BMC pulmonary medicine, 14, 105. doi:10.1186/1471-2466-14-105
Lutfiyya, N., Henley, E. & Chang, L. (2006). Diagnosis and Treatment of Community-Acquired Pneumonia. American Family Physician. 73(3), 442-450
NHS. (2019). Side Effects Antibiotics. Retrieved from
https://www.nhs.uk/conditions/antibiotics/side-effects/
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
Samai, K. (2013). Adverse effects of Antibiotics in the Geriatric Population. Retrieved from
https://lecom.edu/adverse-effects-of-antibiotics-in-the-geriatric-patient-population/
Zagaria, M. (2013). Antibiotic Therapy: Adverse Effects and Dosing Considerations. U.S. Pharmacist. 38(4), 18-20
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