Mr. XYZ, a 55-year-old man with a history of hypertension and COPD, presented with worsening shortness of breath, cough, and fever over the past week. Examination revealed tachycardia, tachypnea, rhonchi in the right lung, and decreased breath sounds. Chest X-ray showed consolidation in the right lower lobe. Blood cultures grew Streptococcus pneumoniae resistant to penicillin and erythromycin but susceptible to ceftriaxone. The patient was treated with IV ceftriaxone and azithromycin and showed clinical improvement.
Mr. XYZ, a 55-year-old man with a history of hypertension and COPD, presented with worsening shortness of breath, cough, and fever over the past week. Examination revealed tachycardia, tachypnea, rhonchi in the right lung, and decreased breath sounds. Chest X-ray showed consolidation in the right lower lobe. Blood cultures grew Streptococcus pneumoniae resistant to penicillin and erythromycin but susceptible to ceftriaxone. The patient was treated with IV ceftriaxone and azithromycin and showed clinical improvement.
Original Title
FDFA8BC2-C08B-465C-9DE3-FEDAF30F2381_Case Study LRTI
Mr. XYZ, a 55-year-old man with a history of hypertension and COPD, presented with worsening shortness of breath, cough, and fever over the past week. Examination revealed tachycardia, tachypnea, rhonchi in the right lung, and decreased breath sounds. Chest X-ray showed consolidation in the right lower lobe. Blood cultures grew Streptococcus pneumoniae resistant to penicillin and erythromycin but susceptible to ceftriaxone. The patient was treated with IV ceftriaxone and azithromycin and showed clinical improvement.
Mr. XYZ, a 55-year-old man with a history of hypertension and COPD, presented with worsening shortness of breath, cough, and fever over the past week. Examination revealed tachycardia, tachypnea, rhonchi in the right lung, and decreased breath sounds. Chest X-ray showed consolidation in the right lower lobe. Blood cultures grew Streptococcus pneumoniae resistant to penicillin and erythromycin but susceptible to ceftriaxone. The patient was treated with IV ceftriaxone and azithromycin and showed clinical improvement.
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Chief complaint
• “I have been short of breath and have been
coughing up brown mucus for the past 3 days” HPI • Mr XYZ is a 55 year-old man with a 3-day history of worsening shortness of breath, fever, chills, right-sided chest pain and a productive cough. The patient states that his initial symptom of SOB began approximately 1 week ago. He has been taking amoxicillin, acetaminophen and an over-the-counter cough and cold preparation, but feels that his symptoms are getting worse. Past medical history • HTN x 15 years • COPD x 10 years
Family history • HTN, Asthma, DM and cancer Social history • Lives with wife and four children • Working as a policeman • Smokes 1 pack per day for the past 30 years • Denies alcohol or IV drug use Medications • Lisinopril 10mg po OD • Hydrochlorothiazide 12.5mg po OD • Ipratropium/albuterol MDI two puffs QID • Amoxicillin 500mg TDS • Acetaminophen 1g PRN Patient admits not compliant to anti-HTN drug because he feels better Physical examination • BP 156/90, P 127, RR 31, T 39.1°C, Wt 88kg, Ht 6’1” • Tachypneic, labored breathing; coarse rhonchi diffusely throughout right lung fields; decreased breath sounds in right middle and lower lung fields • Tachycardia with regular rhythm Labs • Na 142 mmol/L; Hgb 14.2 g/dL; Ca 2.5 mmol/L ; K 3.7 mmol/L ; Hct 42% ; Mg 1.3 mmol/L; Scr 0.9 mg/dL ; WBC 14.7 x 103/mm3 Chest X-Ray • Consolidation of the inferior segments of the LLL as well as the superior segment of the LLL.
Sputum and blood cultures
• Pending Questions 1) What are the patient’s drug therapy problem? 2) What signs & symptoms, laboratory and radiographic findings are consistent with the diagnosis of CAP in this patient? 3) What are the risk factors for pneumonia for this patient? 4) What are the common causative bacteria of CAP? 5) What drug, dose, route, dosing schedule and duration of treatment should be used in this patient and the rationale? In the ward, the patient was initiated on ceftriaxone 1g IV daily and azithromycin 500mg IV daily. Over the next 48 hours, the patient’s clinical status improved with resolving fever, tachypnea, tachycardia and SOB. On day 2, the blood cultures were reported positive with growth of S. Pneumoniae, resistant to penicillin and erythromycin but susceptible to ceftriaxone, levofloxacin and vancomycin. The sputum culture demonstrated only the presence of normal respiratory flora. 6) Given this new information, what changes in the antimicrobial therapy would you recommend and why? Gradually over the course of the next 7 days, the patient’s clinical symptoms resolved and blood cultures performed on hospital day 7 were negative. On day 10, the patient was discharged home on oral antibiotics to complete a 14-day course of treatment. 7) When is it appropriate to convert a patient from IV to oral therapy for the treatment of CAP? 8) What oral antibiotic would be suitable to complete the course of therapy for CAP?
