A 66-year-old male with past medical history of hypertension and hypercholesterolemia presents with 4 day history of dry cough progressing to rusty colored sputum, fever with chills, and malaise. Worsening symptoms of feeling like breathing a little faster than normal, right sided
chest pain with prolonged bout of coughing. No left sided/substernal chest pain, leg swelling, orthopnea, or gastrointestinal symptoms. Chest Xray confirms diagnosis of right lower lobe pneumonia. Patient denies antibiotic use in the last three months.
The decision was made to not obtain sputum cultures at this time as the patient could be treated using empiric treatment antibiotics. The decision was made to start the patient on Azithromycin 500 mg oral for one dose followed by 250mg oral once a day
for the next 4 days.
According to the guideline for inpatients with CAP outside of the intensive care unit (ICU), the preferred antibiotics are β-lactams* plus
macrolides in the United States ( Zhu, Bai, Chen, & Xue 2, 2018).
The decision to use this antibiotic is that it would only be one pill once a day for only a five -day course so compliance would be increased as
poor adherence to medications is well known to result in suboptimal health outcomes
(Sherwin et al., 2021). The patient does not have any contraindications to this medication such as prolonged QT interval (a rare heart problem that may cause irregular heartbeat, fainting,
or sudden death) or a fast, slow, or irregular heartbeat, and if you have low levels of magnesium
or potassium in your blood; if you have a blood infection; heart failure or other heart problems; cystic fibrosis; myasthenia gravis ( National Library of Medicine, 2022).
There are few side effects to this medications such as gastrointestinal intolerance, elevated liver function studies, and prolongation of QT (Arcangelo et.al, 2022).
I would also consider If the patient had been on
recent antibiotics then I would consider sputum cultures so that the organism identified could be specifically treated. If the patient were a pediatric patient I would treat with weight-based dose of
Amoxicillin 90mg/kg per day divided into 2 doses for 10 days. I may consider decongestants or cough suppressants based on efficacy to assist in comforting the patient. I would also recommend increasing oral fluid intake.
