patient's
management
1.
A 56-year-old businessman is planning a trip to
east Asia for a period of 3 weeks. He is in generally good health except for
chronic bronchitis. His medicines control his illness fairly well, but he asks
if he should carry antibiotics with him in case he should develop an
exacerbation. He agrees not to take anything with him, but on his return from
the trip he calls from the airport sounding very short of breath and coughing.
On examination that day, he has a fever of 38.3 °C and loud rhonchi and some
wheezes. A chest radiograph shows some patchy lesions that look worse than on
his baseline radiograph. His capillary oxygen saturation is the same as his
baseline level.
In
addition to treatment for his airway disease, which of the following is the
next step in this patient's management?
Did you get a
point , if not….?????????
Problems of resistance among respiratory bacteria are
worldwide. Although there might be concern about pulmonary embolus in a person
who has recently made a long airplane flight, the clinical picture in this
patient is much more compatible with that of pneumonia. Adjunctive treatments
for chronic obstructive pulmonary disease or bronchitis are good therapy, but
at this stage, it might be necessary to include antibiotics in the mix.
Clavulanate adds nothing to the coverage for S. pneumoniae, although it
might make a difference for Haemophilus influenzae. Problems with the
macrolides are especially severe in east Asia. The majority of strains of S.
pneumoniae are resistant to all the currently available macrolides;
fluoroquinolones, however, still seem to be effective. Intravenous antibiotics
do not seem to be necessary for this patient, but even if they were to be used,
it would make sense to prescribe a drug with more potency for S. pneumoniae.
Either a fluoroquinolone or a better beta-lactam would be suitable.
No comments:
Post a Comment