tommyk
04-09-2006, 07:15 PM
Hy 2122
A 21-year-old woman named Scarlett Johansen who is healthy without underlying medical problems presents to clinic with complaints of temperature up to 101 F and cough with greenish sputum production for 2 days without any dyspnea. She has no sexual history. Lives alone.
Her heart rate is 90/min, and her respiratory rate is 27/min (high). There is no accessory muscle use or conversational dyspnea, nor are there wheezes, bronchial breath sounds, rales, or egophony over the right lower lung fields.
Chest x-ray film reveals a right lower lobe consolidation.
A CBC shows a leukocyte count of 15,000/mm3. Which of the following is the most appropriate pharmacotherapy?
1-Penicillin G
2-Amoxicillin
3-Ampicillin
4-Ceftriaxone
5-Erythromycin
6-Multi-vitamin and yoga
7-Heroin
8-Clindamycin
a) Choose #5, erythromycin (broad spectrum). The first step in the approach to this patient with a community-acquired pneumonia is to categorize her condition by the American Thoracic Society guidelines (1993), which are based on severity of illness, age, comorbidities, and the need for hospitalization. This patient does not meet the criteria for hospitalization (one of the following is needed: respiratory rate > 30 breaths/min, room air PaO2< 60 mm Hg, O2 saturation less than 90% on room air, or bilateral or multiple lobes involved), and she is younger than 60 years without any comorbidities. The most common organisms are Streptococcus pneumoniae, Mycoplasma pneumoniae, Moraxella c., Chlamydia pneumoniae, Haemophilus influenzae, Legionella, and respiratory viruses. Recommended treatment is with erythromycin or a related macrolide, such as azithromycin or clarithromycin. Amoxicillin does not have broad enough coverage to include the organisms listed above. Ceftriaxone and ampicillin are used for hospitalized patients with community-acquired pneumonia. Erythromycin plus ceftriaxone is reserved for patients who are severely ill and hospitalized. Great, you saved her! Kudos!
A 21-year-old woman named Scarlett Johansen who is healthy without underlying medical problems presents to clinic with complaints of temperature up to 101 F and cough with greenish sputum production for 2 days without any dyspnea. She has no sexual history. Lives alone.
Her heart rate is 90/min, and her respiratory rate is 27/min (high). There is no accessory muscle use or conversational dyspnea, nor are there wheezes, bronchial breath sounds, rales, or egophony over the right lower lung fields.
Chest x-ray film reveals a right lower lobe consolidation.
A CBC shows a leukocyte count of 15,000/mm3. Which of the following is the most appropriate pharmacotherapy?
1-Penicillin G
2-Amoxicillin
3-Ampicillin
4-Ceftriaxone
5-Erythromycin
6-Multi-vitamin and yoga
7-Heroin
8-Clindamycin
a) Choose #5, erythromycin (broad spectrum). The first step in the approach to this patient with a community-acquired pneumonia is to categorize her condition by the American Thoracic Society guidelines (1993), which are based on severity of illness, age, comorbidities, and the need for hospitalization. This patient does not meet the criteria for hospitalization (one of the following is needed: respiratory rate > 30 breaths/min, room air PaO2< 60 mm Hg, O2 saturation less than 90% on room air, or bilateral or multiple lobes involved), and she is younger than 60 years without any comorbidities. The most common organisms are Streptococcus pneumoniae, Mycoplasma pneumoniae, Moraxella c., Chlamydia pneumoniae, Haemophilus influenzae, Legionella, and respiratory viruses. Recommended treatment is with erythromycin or a related macrolide, such as azithromycin or clarithromycin. Amoxicillin does not have broad enough coverage to include the organisms listed above. Ceftriaxone and ampicillin are used for hospitalized patients with community-acquired pneumonia. Erythromycin plus ceftriaxone is reserved for patients who are severely ill and hospitalized. Great, you saved her! Kudos!