tommyk
10-04-2006, 03:52 PM
Hy 2413 Microbiology and Pharm…
29-year-old woman who is healthy without underlying medical problems presents to clinic w/ a chief complaint of spiking fevers to 101 F and cough with greenish sputum production for 3 days without any dyspnea. Her heart rate is 90/min, and her respiratory rate is 20/min. 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 drug to use?
1-Amoxicillin
2-Ampicillin-sulbactam
3-Ceftriaxone
4-Erythromycin
5-Erythromycin plus ceftriaxone
a) ans is #4. erythromycin… Amoxicillin is often used in otitis media due to strep pneumo. The first step in the approach to this patient with a community-acquired pneumonia is to categorize her. 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, 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-sulbactam are used for hospitalized patients with community-acquired pneumonia. Erythromycin plus ceftriaxone is reserved for patients who are severely ill and hospitalized.
29-year-old woman who is healthy without underlying medical problems presents to clinic w/ a chief complaint of spiking fevers to 101 F and cough with greenish sputum production for 3 days without any dyspnea. Her heart rate is 90/min, and her respiratory rate is 20/min. 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 drug to use?
1-Amoxicillin
2-Ampicillin-sulbactam
3-Ceftriaxone
4-Erythromycin
5-Erythromycin plus ceftriaxone
a) ans is #4. erythromycin… Amoxicillin is often used in otitis media due to strep pneumo. The first step in the approach to this patient with a community-acquired pneumonia is to categorize her. 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, 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-sulbactam are used for hospitalized patients with community-acquired pneumonia. Erythromycin plus ceftriaxone is reserved for patients who are severely ill and hospitalized.