DISCUSSION POSTS
COMMENT ON THE TWO DISCUSSION POSTS BELOW (1 PARAGRAPH FOR EACH, SUPPORT YOUR RESPONSE WITH A RATIONALE, AND CITE THE SOURCE)
DISCUSSION 1
LT is a 62 yo male diagnosed with community-acquired pneumonia.
1.As the patient’s primary care provider what antibiotic would be a good first-line therapy to try and why?
As the patient’s primary care provider treating LT’s community-acquired pneumonia (CAP) a good first-line therapy should be amoxicillin (Ramirez, 2019). This is a good therapy if the patient does not have allergies or pre-existing co-morbidities. Current recommendations specify amoxicillin (1 g three times daily for 5 days) for outpatient because it provides excellent coverage for Streptococcus pneumonia (Ramirez, 2019). Amoxicillin is a broad-spectrum antibiotic with bactericidal action and acts against both gram-positive and gram-negative microorganisms by inhibiting biosynthesis which leads to the death of the bacteria (Ramirez, 2019). Unless a sputum sample is tested to see what organism the patient has then a broad spectrum is the best fit. Some differences in the microorganisms include Streptococcus pneumonia which is gram-positive whereas Pseudomonas aeruginosa and Klebsiella pneumonia are gram-negative (Ramirez, 2019). Lastly, if LT did have major comorbidities, then oral amoxicillin/ clavulanate (875 mg twice daily) plus a macrolide or doxycycline would be prescribed orally (Ramirez, 2019).
2.What are the monitoring parameters of efficacy and side effects of the agent you picked?
When monitoring amoxicillin for efficacy this should include monitoring for an increase in symptoms, fever, cough, or shortness of breath (SOB) (Akhavan & Praveen Vijhani, 2019). If the patient presents with worsening symptoms within 72 hours of the initial therapy regimen, then lab work and a chest x-ray should be ordered (Akhavan & Praveen Vijhani, 2019). The patient needs to be educated on finishing the full course of antibiotics even when they start feeling better (Akhavan & Praveen Vijhani, 2019). Also, it is essential that patients are aware of hypersensitivity reactions and understand to notify the physician of any rashes (Akhavan & Praveen Vijhani, 2019). The most severe effect to monitor is hypersensitivity which may be a pruritic rash or severe anaphylaxis (Akhavan & Praveen Vijhani, 2019). The most common adverse drug reactions that patients commonly complain about can be gastrointestinal (GI) symptoms such as nausea, vomiting, and diarrhea (Akhavan & Praveen Vijhani, 2019). There is a low instance of patients developing a superinfection like mucocutaneous candidiasis and clostridium difficile-associated diarrhea (Akhavan & Praveen Vijhani, 2019). It is noted that patients taking amoxicillin may have less diarrhea than those on ampicillin because of better gut absorption (Akhavan & Praveen Vijhani, 2019).
3.How would your therapy change if the patient had received antibiotic therapy several weeks prior for a different infection?
If LT had received antibiotic therapy for a different infection weeks prior to presenting with pneumonia, the antibiotic selected may be different. LT should be able to recall what antibiotic was used and if not a call to the pharmacy may confirm. If the antibiotic used in prior weeks was amoxicillin, then a macrolide or doxycycline would be prescribed. This is safe as long as LT does not have any allergies to either of these medications. and azithromycin are sometimes prescribed together to treat pneumonia which would make them safe to Amoxicillin use weeks apart (Welsh, 2022). I would start LT on Zmax (extended-release suspension) 2 grams once as a single dose or 500 mg tablets once a day for several days (Mayo Clinic, 2022).
4.After being treated for pneumonia LT the 62 yo developed severe diarrhea, how will you determine if this is simple antibiotic-associated diarrhea or a Clostridium Difficile infection? If a C. diff infection, how will you treat it?
In order to determine if LT is having simple antibiotic-associated diarrhea or Clostridium difficile (C. diff), a stool sample test would be ordered (Mayo Clinic, 2016). The stool sample will identify either toxins or strains of the bacteria that produce the toxins (Mayo Clinic, 2016). Laboratory stool tests can be done alone or in combination with a NAAT, enzyme immunoassay for C. difficile GDH, enzyme immunoassay for C. difficile toxins A and B, cell culture cytotoxicity assay, or selective anaerobic culture (UpToDate, 2022). If LT’s C. diff comes back positive the recommended treatment would be Vancomycin (Rosenthal & Burchum, 2018). This would be given as Vancomycin 125 mg capsule four times a day for 10 days or Vancomycin IV in extreme and hospitalization is needed (Rosenthal & Burchum, 2018). Vancomycin inhibits cell wall synthesis and promotes bacterial lysis and is only active against gram-positive bacteria (Rosenthal & Burchum, 2018).
DISCUSSION 2
Why is it important to differentiate between pyelonephritis vs. cystitis?
It is important to differentiate between pyelonephritis and cystitis because one needs to know what the disease entails, its causes, and its signs and symptoms. That is, through these differences in knowledge, people understand better what is pyelonephritis and cystitis (Anvarinejad et al., 2012). For instance, cystitis is the inflammation of the bladder commonly caused by the escherichia coli or E. faecalis and symptoms include dysuria, urinary frequency and urgency, suprapubic discomfort, pyuria and bacteriuria (Rosenthal & Burchum, 2021). Whereas, pyelonephritis is the inflammation of the kidneys caused by extended damage to the kidney through ureters and the bacteria associated with this is escherichia coli and Enterobacteriaceae and symptoms include fever, chills, severe flank pain, dysuria, urinary frequency and urgency, and bacteriuria (Rosenthal & Burchum, 2021). Therefore, this knowledge will be important because doctors will be able to apply the correct medication to these diseases based on the causes of the diseases.
As the patient’s primary care provider, what antibiotic would be a good first-line therapy to try if cystitis was suspected and why?
The antibiotic that would be good first-line therapy for suspected cystitis is trimethoprim/sulfamethoxazole 160/800 mg BID for 3 days (Rosenthal & Burchum, 2021). The reason for using this antibiotic therapiy is because this is most likely an uncomplicated UTI considering the patients age and no predisposing factor. Also, majority of the uncomplicated UTI’s are due to e.coli and this line of treatment is considered first choice for this specific bacteria (Rosenthal & Burchum, 2021).
What are the monitoring parameters of efficacy and side effects of the agent you picked?
The monitoring parameters of efficacy would essentially include the absence of the infection. Additional monitoring parameters include CBC with differentialy especially potassium and WBC count, urinalysis with culture and sensitivity, and renal function should be monitored during this antibiotic treatment. Lastly, signs and symptoms should also be monitored to ensure the infection has dissipated. Side effects of trimethoprim/sulfamethoxazole include nausea, vomiting, rash, stevens-johnson syndrome, anemia, agranulocytosis, leukopenia, thrombocytopenia, birth malformations, renal damage, hyperkalemia, headache, depression and hallucinations (Rosenthal & Burchum, 2021).
Would your therapy change at all if she was pregnant?
However, if the patient were pregnant, the therapy would change because trimethoprim should be avoided in pregnancy due to negative effects to the fetus like malformations (Rosenthal & Burchum, 2021). Therefore, cephalexin 500mg TID for 7 to 14 days would be prescribed to a pregnant woman since the woman’s pregnancy is a predisposing factor to a complicate UTI and cephalosporins are safe for use in pregnant women (Rosenthal & Burchum, 2021).
