Question

RR is 48-year-old woman who comes to see you at the V. A. homeless clinic. The major complaint is a six-day history of worsening cough, productive of green sputum. There have been fever and chills with complaints of pain in the right mid-back with deep breathing or coughing. Further history reveals a history of tobacco use of one pack of cigarettes a day for 30 years. There is an inconsistent health history as a result of PTSD and homelessness. On examination, the skin is warm and clammy, pale; RR appears to not feel well; the temperature is 100.5° F; respiratory rate is 24 breaths per minute; pulse is 98 beats per minute; blood pressure is 120/75 mm Hg; and saturation of oxygen is 96 percent on room air by pulse oximetry. Auscultation of the lungs reveals rales in the right lower-posterior lung field. The remainder of the examination is within normal limits. What organism(s) do you most suspect and why? What antibiotic would you recommend to treat RR with and why? What is the mechanism of action of this antibiotic? Do you have any counseling points for RR ?

Answer 1

Based on the above subjective and objective evidence i.e., Green color productive cough,fever,chills and ausculation reveals that rales in the right lower posterior lung field.These case can be assessed as "PNEUMONIA".

1.Organisms that were responsible the infection are:

• Streptococcus pneumonia
• Haemophilus Influenza
• Chlamydia pneumoniae
• Mycoplasma pneumoniae
• Legionella pneumonia

All pneumococcal species may produce green color sputum.

Fluroquinolones,Macrolides and Cephalosporins are used to treat "Pneumonia".

Strongest antibiotic used for pneumonia is "Levofloxacin and Cefuroxime".

Other medication that should be prescribed to RR is: Antipyretic,Cough suppressants

Mechanism of action:

• Levofloxacin: It belongs to L-isomer of of ofloxacin, a quinlone antimicrobial agent and It inhibits bacterial topoisomerase IV and DNA gyrase enzyme required for DNA replication,transcription,repair and recombination.
• Cefuroxime: it is a bactericidal semisynthetic cephalosporin that bind to the target proteins and thereby prevent the synthesis of bacterial cell wall and these antibiotic is resistant for bacterial beta lactamases,particularly the plasmid mediated enzymes of enterobacteriaceae,making it potent against beta-lactamase and other pathogens.

Counseling Points of RR:

• Drink plenty of water or other fluids that helps to loosen mucus.
• Wash your hands regularly with sanitizer ,particularly after touching the nose or mouth and before handling food
• Cover with hand kercheif when sneezing and coughing that will help to prevent virus containing droplets they can infect other.
• Do not share cups or other utensils with other they will spread to other.
• D not take medication without consulting doctor.
• Eat a balanced diet that will heal quickly by improving body function.