Treatment Of Community-Acquired Pneumonia Discussion Response

Treatment Of Community-Acquired Pneumonia Discussion Response

Hello Elana,

Your discussion posting on the recommended treatment of community-acquired pneumonia was enlightening, and I agree. You suggested that the patients’ medicine be changed from azithromycin 500mg qday to levofloxacin 750mg IV for seven days, with continued Ceftriaxone 1g IV. The availability of comorbidities is an essential issue to consider in managing Community-Acquired Pneumonia (CAP). Patients with comorbidities are given broad-spectrum antimicrobials. This is because such patients are likelier to have a poor outcome if the initial regimen fails. Another explanation is that the patients have a history of antibiotic usage (Rider & Frazee, 2018). Thus in planning the medications to be used, this should be factored. Your client had a PMH of HTN, diabetes, and hyperlipidemia Treatment Of Community-Acquired Pneumonia Discussion Response.

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Aside from levofloxacin, another option to consider is doxycycline. Doxycycline is used as an alternative to macrolides in therapy. The need for adding doxycycline into medication therapy stems from growing worries about developing drug resistance to macrolides (Metlay et al., 20190. In response to developing medication resistance, several novel medicines are being launched to treat CAP. One of the drugs mentioned is omadacycline. The research found that omadacycline, like moxifloxacin, is beneficial in treating mild to moderate CAP. Furthermore, the medication can be used to treat tetracycline resistance. Doxycycline would have been employed as an alternative to azithromycin based on your clients’ needs.

The significance of proper CAP treatment is due to the associated health burden. It leads to more extended hospital stays, which raises the cost of healthcare (Ticona et al., 2020). Suitable antibiotic selection for each patient based on their medical comorbidities and severity assessment enables meaningful determination of the causative pathogens and appropriate prescription selection. As a result, this is one step toward reducing the growth of antimicrobial drug resistance.

Read a selection of your colleagues’ responses from Week 9 and respond to at least two of your colleagues on two different days who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples.

Elana Kalus

Patients Health Needs (Case Study 1)

The patient described in case 1 is a 68-year-old male that has been admitted to the medical ward with community-acquired pneumonia (CAP) for the past three days; the patient has a PMH of COPD, HTN, hyperlipidemia, and diabetes. He is currently on day 3 of empiric antibiotics (ceftriaxone 1g IV qday and azithromycin 500mg IV qday). The clinical status of this patient is improving with decreased oxygen requirements; he presents with complaints of nausea and vomiting and is not tolerating a diet at this time.

Based on the information provided in case 1, it is apparent that patient HH has several health needs that will need to be addressed. Some of the patient’s health needs are nutrition based; the patient is not tolerating a diet due to nausea and vomiting and is dehydrated as seen by the high lab level of bicarbonate, and will therefore need IV fluids and electrolyte replenishment as well as encouragement to progress towards small frequent oral intake tolerance; according to Eekholm et al. (2020), in their study, the results showed that on average 76% older adults ages 65 and older with CAP have nutritional deficiencies and implementing a personalized nutritional support plan is essential in treatment and recovery of CAP in hospitalized older adults. In order to personalize a nutritional support plan for this patient, it is crucial to incorporate the patient’s complaints of N/V, and their comorbidities of hyperlipidemia and diabetes, as these will impact the patient’s nutritional plan (Eekholm et al., 2020). Additionally, nausea and vomiting should be directly addressed through the prescription of an antiemetic drug; one recommendation would be to prescribe Ondansetron 4mg IM q8hr PRN for nausea/vomiting; IM or IV route would be best due to the patient not being able to tolerate PO intake at this time due to nausea and vomiting (Rosenthal & Burchum, 2021). In order for this patient to effectively respond to antibiotic treatment and overall treatment of CAP, nutritional status, N/V, and dehydration must be managed (Eekholm et al., 2020).

Recommended Treatment Regimen

In addition to starting IV fluids for dehydration and an antiemetic regimen as needed for nausea and vomiting, I would recommend some changes in the patient’s current empiric antibiotic treatment regimen. The patient is currently on day three of the following empiric antibiotic regimen: ceftriaxone 1g IV qday and azithromycin 500mg IV qday. In this case, the organism responsible for CAP is Streptococcus pneumoniae, as it is noted in the labs that there is a heavy growth of this organism with a right lower lobe infiltrate noted on the CXR. My recommendation would be to discontinue azithromycin, to continue ceftriaxone 1g IV qday, and to start Levofloxacin 750mg IV qday for seven days (File, 2021; Metlay et al., 2019; Rosenthal & Burchum, 2021). Noted on the second page of the study are several antibiotics, MIC, and interpretation; it can be seen here that erythromycin is resistant to this organism, and therefore I would recommend discontinuing azithromycin as they are both macrolides and similar in structure and function (Rosenthal & Burchum, 2021). Additionally, I would continue ceftriaxone 1g IV qday, and start Levofloxacin 750mg IV qday as both of these antibiotics have good susceptibility to the organism Streptococcus pneumoniae and are recommended by national guidelines for the treatment of CAP in individuals with comorbidities present in this patient such as COPD and DM; I would continue with IV abx therapy while the patient is not tolerating PO intake and I would avoid penicillin due to the patients know allergy to penicillin with rash reaction (File, 2021; Metlay et al., 2019; Shoar & Musher, 2020). While there are several treatment options for CAP, due to the patient’s comorbidities, current clinical status, labs, organism susceptibility to abx treatment, and allergy, I would recommend the treatment regimen outlined above as it is consistent with national treatment guidelines for CAP (Metlay et al., 2019).

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Patient Education Strategy

A huge component of providing holistic care for any patient is providing patient education that is understood by the patient so that they can be successful in helping to manage their health needs; by implementing patient education strategies, patients can better understand the education provided to them by their healthcare providers (Rosenthal & Burchum, 2021; Yen, & Leasure, 2019). In this case, it is very important to provide patient education on the risk factors of CAP, such as the patients’ comorbidities of COPD and DM, which need to be properly managed to avoid future susceptibility to reoccurring CAP infections; additional risk factors that I would educate my patient about are the importance of avoiding tobacco products, the importance of maintaining good nutritional status, and avoidance of traveling to places where the risk for CAP are high (Elsevier, 2020). I would also provide teaching on identifying signs and symptoms of CAP early and the importance of seeking healthcare if symptoms arise, and would counsel the patient on receiving the pneumococcal vaccine if they are not yet vaccinated (Elsevier, 2020). The patient education strategy I would utilize while providing patient education is the teach-back methodology; I would encourage the patient to ask questions and would ask the patient to repeat back and teach me the education I have provided to them as it has been found that the teach-back strategy is beneficial in reinforcing patient education (Yen, & Leasure, 2019)Treatment Of Community-Acquired Pneumonia Discussion Response.

References

Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & Whitney, C. G. (2019). Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine, 200(7), e45-e67. https://doi.org/10.1164/rccm.201908-1581st Treatment Of Community-Acquired Pneumonia Discussion Response

Rider, A. C., & Frazee, B. W. (2018). Community-Acquired Pneumonia. Emerg Med Clin North Am, 36(4), 665-683. https://doi.org/10.1016/j.emc.2018.07.001

Ticona, J. H., Zaccone, V. M., & McFarlane, I. M. (2020). Community-Acquired Pneumonia: A Focused Review. Am J Med Case Rep., 9(1), 45-52. https://doi.org/10.12691%2Fajmcr-9-1-12 Treatment Of Community-Acquired Pneumonia Discussion Response