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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 (196 pounds)
Allergies: Penicillin (delayed, rash)
Facilitator/Faculty Tips to do well:
NEED SUBSTANTIVE DISCUSSION.
Discuss very briefly any pharmacological intervention patient is presently on for COPD, HTN, hyperlipidemia & diabetes. Just one or two lines each on what would be drugs used, pharmacological relevance on treating these diseases.
Thoroughly discuss the anti-infective drugs used for for treating the infection Community Acquired Pneumonia (pharmacology to include mechanism of action, therapeutic effects, adverse effects, kinetics etc.).
Is the current empiric therapy based on any guidelines?
If allergic to penicillin, why was ceftriaxone given, which is another beta-lactam antibiotic (a cephalosporin which is also a beta lactam antibiotic)?
If penicillin allergy was immediate type, what are the alternate options for treating CAP? (tips: Doxycycline? Levofloxacin?)
Need a thorough discussion on a case like this on ADVANCED PHARMACOLOGY, CLINICIAN LEVEL.
USE PEER REVIEWED SCHOLARLY, US BASED, CURRENT, PRIMARY SOURCE, CLINICIAN BASED (NOT PATIENT BASED) REFERENCES.