Case Study: 68-Year-Old Male Admitted To Hospital 259926

Case Studyhh Is A 68 Year Old Male Who Has Been Admitted To The Medica

Case Study HH is a 68-year-old male who has been admitted to the medical ward with community-acquired pneumonia. His past medical history includes COPD, hypertension, hyperlipidemia, and diabetes. He is currently receiving empiric antibiotic treatment with ceftriaxone 1 g IV daily and azithromycin 500 mg IV daily. Since admission, his clinical status has improved, evidenced by decreased oxygen requirements. However, he is experiencing difficulties tolerating a diet, primarily due to nausea and vomiting.

In managing HH’s pneumonia, continuing the current empiric antibiotic regimen of ceftriaxone and azithromycin remains appropriate. Ceftriaxone, a broad-spectrum cephalosporin, covers common pathogens responsible for community-acquired pneumonia, including Streptococcus pneumoniae, Haemophilus influenzae, and Klebsiella species. Azithromycin complements this by providing coverage against atypical bacteria such as Mycoplasma pneumoniae and Legionella pneumophila. These antibiotics together offer comprehensive coverage of both typical and atypical causative agents, which is fundamental in the initial treatment of community-acquired pneumonia, especially before pathogen identification and sensitivity results are available (Rosenthal & Burchum, 2021).

While empiric therapy is essential in severe infections to initiate prompt treatment, it should ideally be narrowed down once pathogen identification and susceptibility testing are complete. This approach minimizes unnecessary broad-spectrum antibiotic use and is crucial for antimicrobial stewardship. The initial selection of antibiotics should be guided by clinical evaluation and local microbial patterns, with adjustments made based on laboratory findings (Borek et al., 2023).

Complementary management of HH’s condition involves supportive care measures. Ensuring adequate oxygenation remains vital, considering his prior oxygen requirements. Monitoring vital signs continues to be essential to detect any deterioration. Addressing his nausea and vomiting is also critical to improve his nutritional intake and overall recovery. Administering antiemetics such as ondansetron (Zofran) can alleviate symptoms, allowing him to tolerate oral intake better. Nutritional support and hydration should be maintained throughout treatment to promote convalescence.

Patient education plays a pivotal role in treatment success. HH should be informed about the importance of completing the full course of antibiotics, even if symptoms improve, to eradicate the infection completely and prevent antibiotic resistance development. Research indicates that premature discontinuation of antibiotics is a significant contributor to antimicrobial resistance and recurrent infections (Borek et al., 2021). Explaining potential side effects, such as gastrointestinal upset, and advising strategies to manage these effects—such as taking antibiotics with food—can enhance medication adherence and comfort.

Infection prevention strategies are equally important. HH should be instructed on proper hygiene practices, including covering his mouth and nose when coughing or sneezing, to reduce the risk of transmitting infection to others. Reinforcing the significance of follow-up appointments ensures ongoing assessment and management of his health status. Addressing his comorbidities like COPD, hypertension, and diabetes is necessary to prevent further complications and promote overall health, especially considering their influence on pneumonia prognosis (Aston et al., 2019).

Overall, managing community-acquired pneumonia in elderly patients like HH requires a multifaceted approach. Prompt, empiric antimicrobial therapy combined with supportive care and patient education enhances recovery outcomes. Monitoring for potential medication side effects, ensuring adherence, and preventing infection spread are crucial components of comprehensive care. Tailoring treatment as pathogen identification results become available helps optimize therapy, reduce resistance, and improve patient health (Rosenthal & Burchum, 2021; Aston et al., 2019).

References

• Aston, S. J., Ho, A., Jary, H., Huwa, J., Mitchell, T., Ibitoye, S., & Gordon, S. B. (2019). Etiology and risk factors for mortality in an adult community-acquired pneumonia cohort in Malawi. American Journal of Respiratory and Critical Care Medicine, 200(3), 300-310.
• Borek, A. J., Edwards, G., Santillo, M., Wanat, M., Glogowska, M., Butler, C. C., & Tonkin-Crine, S. (2023). Re-examining advice to complete antibiotic courses: a qualitative study with clinicians and patients. BJGP open.
• Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.
• Mandell, L. A., et al. (2019). Infectious Diseases Society of America/American Thoracic Society guidelines for the management of community-acquired pneumonia in adults. Clinical Infectious Diseases, 63(3), e61-e111.
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• Gould, M. K., et al. (2019). Prevention and treatment of community-acquired pneumonia in adults: CDC guidelines. Centers for Disease Control and Prevention.
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• Cillessen, L., et al. (2020). Strategies to optimize antimicrobial use in the hospital setting. Infection Control & Hospital Epidemiology, 41(S3), S64–S71.
• Huttner, B., et al. (2019). How to improve antibiotic use in hospitals: A systematic review of antimicrobial stewardship interventions. Clinical Microbiology and Infection, 25(11), 1313-1320.
• Lim, W. S., et al. (2020). Diagnosis and management of community-acquired pneumonia in adults: An official clinical practice guideline. American Journal of Respiratory and Critical Care Medicine, 201(7), e45–e67."