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  #1  
Old 06-02-2012
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Lungs emperic treatment of this pneumonia ?

A 35-year-old woman is evaluated in the emergency department in December because of fever, confusion, and shortness of breath. Three days ago, she became ill with fever, sore throat, myalgias, and cough. Her symptoms rapidly worsened. Her medical history is unremarkable. Influenza infection has been reported in the community. On physical examination, temperature is 40.0C (104.0F), blood pressure is 82/48 mm Hg, heart rate is 130/min, respiration rate is 36/min, and pulse oximetry is 86% on ambient air. Pulmonary examination reveals bilateral diffuse crackles. The patient is intubated and receives mechanical ventilation and is admitted to the intensive care unit. The leukocyte count is 2200/μL (2.2 109/L) with 82% segmented neutrophils and 10% band forms. The chest radiograph shows multilobar pneumonia. Sputum and blood cultures are sent, and intravenous fluids are started.

Which of the following is the most appropriate empiric antibiotic therapy for this patient?

(A) Ceftriaxone and azithromycin
(B) Clindamycin
(C) Cefotaxime, levofloxacin, and vancomycin
(D) Piperacillin-tazobactam
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Old 06-02-2012
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firstly this is community acquired pneumonia.

CAP is treated
OPD-- doxy/azithro +/- FQ(if comorbidites or RTI in past 3 months)

IPD-- FQ or CEFTRIAXONE + AZITHRO

so answer is A
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Old 06-02-2012
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pt has sepsis with leukocytopenia and Mutilobar pneumonia after influenza
i will go with (C) Cefotaxime, levofloxacin, and vancomycin
cuz its the only one that cover MRSA, though i dont know why giving Cefotaxime, levofloxacin together
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Old 06-02-2012
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damn!!!! totally missed the application of the baterial pneumonia post influenza.!

what are the most common organisms?
stap, strep pneumo and h. influenza right?
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Old 06-02-2012
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But I think, as culture result r pending so better to go for > (A) Ceftriaxone and azithromycin
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I will go for C aswell.
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Quote:
Originally Posted by bisho View Post
pt has sepsis with leukocytopenia and Mutilobar pneumonia after influenza
i will go with (C) Cefotaxime, levofloxacin, and vancomycin
cuz its the only one that cover MRSA, though i dont know why giving Cefotaxime, levofloxacin together
you are correct buddy and your explanation nice1.

regarding why weird cefotax-levoflox combo..here whats written...
Quote:
The most appropriate empiric antibiotic therapy for this patient
is cefotaxime, levofloxacin, and vancomycin. Methicillin-resistant
Staphylococcus aureus (MRSA) should be suspected in persons
with severe, rapidly progressive pneumonia, especially during
influenza season; in those with cavitary infiltrates on the chest
radiograph; or in those with a history of MRSA infection.
Administering cefotaxime and levofloxacin for a patient who is
admitted to the intensive care unit (ICU) with pneumonia and
no risk factors for Pseudomonas
aeruginosa infection (for
example, bronchiectasis, corticosteroid or broad-spectrum
antibiotic use in the previous month, malnutrition) is
appropriate.
i wasnt knowing that this combo okay for pneumonia... thoughts?
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Quote:
Originally Posted by tyagee View Post
you are correct buddy and your explanation nice1.

regarding why weird cefotax-levoflox combo..here whats written...


i wasnt knowing that this combo okay for pneumonia... thoughts?
But aren't we supposed to cover for Pseudomonas in a neutrpenic patient ?

Quote:
Administering cefotaxime and levofloxacin for a patient who is
admitted to the intensive care unit (ICU) with pneumonia and
no risk factors for Pseudomonas aeruginosa infection (for
example, bronchiectasis, corticosteroid or broad-spectrum
antibiotic use in the previous month, malnutrition) is
appropriate.
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