Question

While in the ED, the patient was placed on 4 liters of oxygen via nasal cannula. Oxygen saturation improved to 98%. The patient was initiated on Ceftriaxone 1 gram IV daily and azithromycin 500 mg IV daily and admitted to the hospital. Over the next 48 hours, the patent's clinical status improved with decreasing fever, tachypnea, tachycardia, and shortness of breath. On hospital day 2, the S. pneumoniae urine antigen was positive, and the sputum culture demonstrated the growth of S. pneumoniae, resistant to erythromycin (MIC >1 mcg/mL), but susceptible to penicillin (MIC < 2 mcg/mL), ceftriaxone (MIC < 1 mcg/mL), levofloxacin (MIC<0.5 mcg/mL), and vancomycin (MIC < 1mcg/mL). Given this new information, what changes in the antimicrobial therapy should be recommended? If the patient had a severe penicillin allergy, what treatment alternatives are available? What oral antibiotic would be suitable to complete the course of therapy for CAP in this patient? When is it appropriate to convert a patient from IV to oral therapy for the treatment of CAP?

Answer 1

1.Pneumococci which is resistant to erythromycin are resistant to azithromycin as well. I think it would be better to change to Vancomycin.

2.In patients with pencillin allergy, alternative medications such as Vancomycin are often used .

4.convert to oral as soon as there is clinical improvement, WBC decrease, afebrile, stable, functioning Gastrointestinal tract able to tolerate oral medication, taking other scheduled medicines orally ,no nausea or vomiting. Patients will start getting better in 2-4 days if not ,consider resistance.