Please do a short response for the following :
GROUP A
LT is a 62 yo male diagnosed with community acquired pneumonia.
As the patient’s primary care provider what antibiotic would be a good first line therapy to try and why?
Amoxicillin 1 gram tid times 7 days. Amoxicillin is a widely prescribed, oral therapy for an outpatient CAP (Armstrong, 2020). This is assuming that he can be treated as an outpatient with no comorbidities.
Community Acquired Pneumonia (CAP) is commonly caused by Streptococcus pneumoniae and Mycoplasma pneumoniae, Haemophilus influenzae, and Staphylococcus aureus (Rosenthal & Burchum, 2020, p. 655).
The initial treatment regimen for outpatients with CAP (for patients with no risk factors for MRSA or Pseudomonas aeruginosa; and no comorbidities on alcoholism, asplenia, diabetes mellitus, malignancy or chronic heart, lung, liver or kidney disease) are (Armstrong, 2020) :
• amoxicillin 1 g three times daily , or
• doxycycline 100 mg twice daily, or
• a macrolide (azithromycin 500 mg on first day then 250 mg daily or clarithromycin 500 mg twice daily or clarithromycin extended release 1,000 mg daily) .
What are the monitoring parameters of efficacy and side effects of the agent you picked?
Monitor amoxicillin treatment for therapeutic effects such as reduction of fever, edema, pain and inflammation, mentation, ability to eat. Duration of therapy is based on patient’s clinical response. It is a minimum of 5 days and being afebrile and clinically stable for at least 48 hours. Mild pneumonia generally requires 5 to 7 days, while severe infection takes 7 to 10 days. Extended courses may be needed for immunocompromised patients or those with complications (Ramirez, 2024)
For patients with renal impairment, monitor for accumulation and toxic levels. Monitor for allergic reactions (Rosenthal & Burchum, 2020, p. 668). Other adverse effects may be superinfections in the form of mucocutaneous candidiasis and Clostridium difficile-associated diarrhea (CDAD); and hepatotoxicity whit significant elevations in aspartate transaminase (AST) and alanine transaminase (ALT) (Akhavan et al., 2023).
How would your therapy change if the patient had received antibiotic therapy several weeks prior for a different infection?
Because the previous antibiotic therapy may have introduced antibiotic resistance, laboratory specimen should be obtained, for which the infecting microbe can be identified and tested for drug sensitivity (Rosenthal & Burchum, 2020, p. 655). While the lab results are unavailable, the broad spectrum antibiotic regimen can be initiated until the results come out and we can switch to a narrow spectrum antibiotic.
After being treated for pneumonia LT the 62 yo developed severe diarrhea, how will you determine if this is simple antibiotic associated diarrhea or a Clostridium Difficile infection? If a C. Diff infection how will you treat it?
C. Diff infection (CDI) can be identified with having three or more watery stools a day and a positive stool test for C. diff and its toxins (Rosenthal & Burchum, 2020, p. 674). CDI is usually preceded by the use of antibiotics (clindamycin, second and third generation cephalosporins and fluoroquinolones) that kills off normal gut flora and allows the C. diff to multiply. Treatment for severe C. Diff requires stopping the antibiotic and starting with another. The preferred drug therapy for C. Diff is Vancomycin 125 mg PO qid or fidaxomicin 200 mg PO bid for 10 days.
