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Case Study 17

Case Study 17. Yoontaek Lim (Clark). Patient History.

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Case Study 17

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  1. Case Study 17 Yoontaek Lim (Clark)

  2. Patient History • MC., a 60 y/o male, has already experiencing nausea, vomiting and diarrhea aside from having developed Pneumonia while in the hospital. Lab exams and his other manifestations revealed that the patient is already suffering from sepsis

  3. Pneumonia?

  4. Definition • Swelling of the lungs of that can be caused by many different organisms. The symptoms can vary considerably, depending on the cause. • Incidence • In the United States • Over 2 million people are found to have pneumonia • Over 50,000 of those individuals die • The sixth leading cause of death in the United States • In developing countries, pneumonia is either the first or second leading cause of death.

  5. Causes • Pneumonia is caused by bacteria, viruses, fungi, or parasites. • Predisposing factors • Viral respiratory infections, alcoholism, smoking, age extremes, debility, dysphagia, altered consciousness, therapies that depress the immune system, and underlying disease states such as heart failure, chronic obstructive pulmonary disease, or immunosuppressive disorders. • Individuals in hospitals for other disorders are also at high risk. • The most common types, which are bacterial, are Pneumococcus, Staphylococcus, Streptococcus, Klebsiella, and Haemophi-lus pneumonia.

  6. Symptoms • Bacterial • Abrupt onset with shaking chills, cough, dyspnea, sputum production (often rust or salmon colored), pleurisy; nausea, vomiting, malaise, and myalgia also may be present • Viral • Headache, fever, myalgia, cough with mucopurulent sputum • Mycoplasmal • Malaise, sore throat, dry cough with rapid progression to productive cough with mucoid, purulent, and blood-streaked sputum • Fungal • Fever, dyspnea, and a dry, nonproductive cough that evolves over several days or weeks are the first symptoms. Increasing shortness of breath usually prompts the individual to seek treatment. The onset tends to be more acute in individuals who do not have AIDS. • Aspiration • Dyspnea, cyanosis, hypotension, tachycardia

  7. Potential Complications • Septic shock, lung abscess, respiratory failure, bacteremia, endocarditis, pericarditis, and meningitis are possible complications.

  8. Treatment • Treatment of pneumonia is bed rest, fluids, antibiotics, painkillers, and if needed, oxygen. Ice packs or cold, wet compresses may be needed to lower the fever. Fever, loss of fluids and breathing through the mouth result in a need for special care of the mouth and nose. Mild pneumonia is often treated at home

  9. Antimicrobial therapy for Pneumonia

  10. Antimicrobial combination for this case Macrolide (Erythromycin) + Cefotaxime, Cefriaxone

  11. Macrolide (Erythromycin) • Drug of choice for community-acquired pneumonia that does not require hospitalization • Covers streptococcus pneumoniae, mycoplasma pneumoniae, chylamydia trachomatis • One of the safest antibiotics • New agent • Extended coverage includes S aureus & H influenza • Clarithromycin : mycobacterium avium • Azithromycin : chlamydia

  12. Cephalosporin; 3rd generation • Cefotaxime, Cefriaxone • Used for the multi-drug resistant aerobic gram(-) organism that cause nosocomial pneumonia, meningitis, sepsis, and urinary tract infections

  13. Dose

  14. Mechanism of action

  15. Erythromycin • Binds to 50S ribosomal subunits & inhibits protein synthesis • Cefotaxime, Cefriaxone • Competitive inhibitor of the transpeptidase enzyme; inhibits bactarial cell wall synthesis

  16. Adverse effects

  17. Erythromycin Gastrointestinal disturbance : most common but not serious Hypersensitivity reaction : skin rashes, fever Transient hearing disturbance Longer treatment (>2weeks) : cholestic jaundice Oppotunistic infection of the gastrointestinal tract or vagina Cefotaxime, Cefriaxone Hypersensitivity

  18. Pharmacokinetics of ribosomal inhibitors ; Macrolides

  19. Pharmacokinetics of macrolide • Administration : oral or IV • Concentrate in the liver • Elimination : mostly in the bile • Erythromycin : partly in the liver • Diffuse readily into most tissue bur cannot cross the blood-brain barrier and poor penetration into synovial fluid • T1/2 : Erythrocyte 90min • Clarithromycin : 3 X, azithromycin : 8~16 X

  20. When intra-abdominal source is suspected,what is the agent to be used? Clarithromycin ; low gastrointestinal intolerance

  21. THANKS FOR LISTENING!!!

  22. References • Rang H.P et al, Drugs used in the treatment of infections and cancer : Pharmacology, 5th ed. Churchill Livingstone, 2003, pp 619-710 • Betram G. K, Chemotherapeutic agent : Basic&clinical Pharmacology, 9th ed. Mcgraw-Hill edutation, 2004, pp 734-763 • Mark G et al, Anti-bacterial Mediation : Clinical Microbiology mrs, 3rd ed. Miami MedMaster Inc, 2004, pp 114-132 • Vinay K et al, The Lung : Robbins and Cotran Pathologic Basis of Disease, 7th ed. Elsevier Inc, 2005, pp 711-773

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