Week 9 discussion Initial post Pneumonia Pneumonia can be bacterial, viral, atypical, mycoplasma, legionnaires disease, fungal, community, or hospital-acquired. Aliberti et al. (2019) discussed how streptococcus pneumonia was the most frequently identified pathogen in a cohort of patients with community-acquired pneumonia. A few risk factors associated with community-acquired pneumonia are age, male gender, smoking, alcoholism, respiratory disease, and dementia. To diagnose pneumonia, an APRN should do a thorough history and physical exam, order a chest X-ray, and draw blood tests like a complete blood count (CBC) to see if there is an increase in the white blood cell count (WBC). An increase in WBCs would indicate that the immune system is fighting an infection. In this case, HH is a 68-year-old male with a history of COPD, hypertension, hyperlipidemia, and diabetes. HH's age, gender, history of COPD, and diabetes put him at an increased risk for pneumonia. The typical bacteria causing community-acquired pneumonia include Streptococcus pneumonia, Hemophilus influenza, and Moraxella catarrhalis. HH has been started on ceftriaxone 1 gram IV qday. Ceftriaxone is a third-generation cephalosporin antibiotic and must be used with caution in patients with diabetes. HH is also on azithromycin, a macrolide antibiotic whose mechanism is to bind to 50S and block polypeptide exit tunnels to prevent chain elongation, thus making it bacteriostatic. The adverse effects of azithromycin are nausea, vomiting, diarrhea, and abdominal pain. HH has been feeling nauseated, vomited, and not tolerating his diet since starting azithromycin. The treatment regimen I recommend for HH is starting on amoxicillin/clavulanate 875mg/125mg PO BID for 7 days, with Azithromycin 500mg PO qDay on day 1 and take day 2-5 250mg PO qDay. Amoxicillin/clavulanate is a semi-synthetic antibiotic with a broad spectrum of bactericidal activity covering gram-negative and gram-positive microorganisms. The amoxicillin/clavulanate mechanism is that the amoxicillin will bind to the penicillin-binding proteins and inhibit the final transpeptidase step of peptidoglycan synthesis of bacterial walls with the clavulanate inhibiting beta-lactamase-producing bacteria allowing amoxicillin the extended spectrum of action (Raghad et al., 2022). Amoxicillin/clavulanate should be taken with food that is not rich or spicy to decrease the risk of GI upset. HH should also take azithromycin 500mg PO qDay on day 1 and day 2-5 take 250mg PO qDay because it concentrates on phagocytes and fibroblasts. This suggests that when azithromycin blocks the disassociation of peptidyl tRNA from ribosomes, causing RNA- dependent protein synthesis, the drug will concentrate on phagocytosis to relieve the inflamed tissues from pneumonia. Amoxicillin/clavulanate and azithromycin are used together to treat streptococcus pneumoniae, which is the leading cause of community-acquired pneumonia. HH should be sent home and told to call if there are any adverse reactions like nausea, diarrhea, vomiting, headaches, dizziness, or tiredness. Also, HH should be given educational handouts with information on each antibiotic prescribed and information on a nutritional diet to encourage compliance. The diet should include eating small meals, avoiding processed meat, alcohol, sugary drinks, and foods high in sodium, and drinking fluids to avoid dehydration. HH should rest and stay away from smoke and other people while his lungs heal. Heo et al. (2020)
discussed how smoking and neutropenia were risk factors affecting pneumonia development. HH should be told to take all the antibiotics till the prescription is done, even if he starts feeling better. References Aliberti, S., Cook, G. S., Babu, B. L., Reyes, L. F., H. Rodriguez, A., Sanz, F., Soni, N. J., Anzueto, A., Faverio, P., Sadud, R. F., Muhammad, I., Prat, C., Vendrell, E., Neves, J., Kaimakamis, E., Feneley, A., Swarnakar, R., Franzetti, F., Carugati, M., Restrepo, M. I. (2019). International prevalence and risk factors evaluation for drug-resistant Streptococcus pneumoniae pneumonia.Journal of Infection, 79(4), 300-311
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