The Patient’s Health Needs
The patient is a 68-year-old male admitted for community-acquired pneumonia, with infiltrates in the right lower lobe. Clinical presentation includes high fever (102.7 F), hemoptysis, gastrointestinal symptoms, and fatigue. He displayed some significant improvement on the third day, including decreased oxygen requirements, a normal heart rate, and a decreasing HCO3 range after receiving empiric antibiotics such as a daily dose of one-gram IV of ceftriaxone and 500 mg azithromycin IV. However, the patient is not tolerating a diet, coupled with complaints of nausea and vomiting. Moreover, the patient is allergic to penicillin and resistant to erythromycin and tetracycline, evidenced by a minimum inhibitory concentration (MCI) of >16. The goal of the treatment is to inhibit the growth of streptococcus pneumoniae, stabilize the patient’s arterial blood gases, ensure optimal general health, and eliminate feelings of nausea and vomiting.
The treatment of community-acquired pneumonia (CAP) should be based on the patient’s characteristics. For instance, the patient is an older adult male with COPD and an allergic reaction to penicillin. The preferred antibiotics for the treatment of CAP are doxycycline, macrolides, or fluoroquinolones (Bidell, Pai, & Lodise, 2020). However, the MCI of > 16 for erythromycin and tetracycline indicates resistance to some macrolides. Azithromycin 500 mg IV is the first-line treatment, as recommended by the CDC and its success on the patient in improving the symptoms (Mandell et al., 2017). Though, considering the patient’s COPD and use of antimicrobials, I would recommend the following, in line with CDC recommendations:
- levofloxacin (750 mg/day) and monitor for adverse effects or
- amoxicillin-clavulanate 875 mg [twice daily).
Using bronchodilators for COPD together with azithromycin could increase the risk of tachycardia, considering that this patient had a fast heart rate on admission (Noor et al., 2019). Bronchodilators include Albuterol and Salmeterol (Rosenthal & Burchum, 2021). Also, Level I evidence suggest that the treatment should be maintained for five days. Discontinue penicillin due to its rash effect on the patient. Furthermore, Azithromycin may excercabate nausea and vomiting in patients with gastrointestinal issues.
The caregiver should recommend pneumococcal polysaccharide vaccine for the at-risk patient. Secondly, advice the patient to maintain the medication for at least five days and report any adverse effects associated with levofloxacin (nausea and vomiting) or amoxicillin-clavulanate (mild diarrhea, rash, and vomiting). Levofloxacin tablets can be taken with or without food, but avoid dairy products two hours prior as it hinders the effectiveness of the drug (Noor et al., 2019).
Bidell, M. R., Pai, M. A. P., & Lodise, T. P. (2020). Use of Oral Tetracyclines in the treatment of adult patients with community-acquired bacterial pneumonia: a literature review on the often-overlooked antibiotic class. Antibiotics, 9(12). 905-927. Retrieved from https://www.mdpi.com/2079-6382/9/12/905/pdf
Mandell, L. A., Wunderink, R. G., Anzueto, A., Bartlett, J. G., Campbell, G. D., Dean, N. C., … & Whitney, C. G. (2017). Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clinical infectious diseases, 44(Supplement_2), S27-S72.
Noor, S., Ismail, M., & Ali, Z. (2019). Potential drug-drug interactions among pneumonia patients: do these matter in clinical perspectives?. BMC Pharmacology & Toxicology, 20(1). Retrieved from https://doi.org/10.1186/s40360-019-0325-7
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.