Description
Expectations (Inna)
Length: A minimum of 180 words, not including references
Citations: At least one high-level scholarly reference in APA from within the last 5 years
Relate to another studies
Etiology
The most common bacterial causes of Community-Acquired Pneumonia (CAP) include Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Staphylococcus aureus, Legionella species, Chlamydia pneumoniae, and Moraxella catarrhalis. While viral pathogens are increasingly recognized as a cause of CAP, current guidelines recommend empirical treatment for bacterial infection in all CAP patients. This recommendation is based on the absence of rapid and specific diagnostic tests that can conclusively confirm viral etiology at the time of presentation. Moreover, it’s noted that patients with CAP attributed to viral causes often exhibit concurrent bacterial coinfections (Dlugasch & Story, 2024).
The recommended empirical treatment for Community-Acquired Pneumonia (CAP) in the outpatient setting depends on whether the patient has comorbid conditions or risk factors for drug-resistant pathogens (Dlugasch & Story, 2024).
For Patients Without Comorbid Conditions or Risk Factors:
Monotherapy with one of the following is recommended: amoxicillin, doxycycline, or a macrolide (azithromycin or clarithromycin). However, the use of macrolide monotherapy is now a conditional recommendation due to increasing resistance rates. A macrolide should not be used if the local rate of pneumococcal resistance to macrolides exceeds 25%. In the U.S., the average rate of resistance is about 30% (Arcangelo, 2022).
For Patients With Comorbidities:
Broader-spectrum coverage is recommended due to the likelihood that these patients may have risk factors for antibiotic resistance.
Options include:
Monotherapy with a respiratory fluoroquinolone (levofloxacin, moxifloxacin, or gemifloxacin)
Combination therapy with amoxicillin-clavulanate or a cephalosporin plus a macrolide or doxycycline (Arcangelo, 2022).
The rationale for using broader-spectrum coverage in patients with comorbidities is that they are more likely to have had previous healthcare-system contact or prior antibiotic use, increasing their susceptibility to antibiotic resistance. Providing appropriate initial empirical coverage is crucial in these cases to avoid poor treatment outcomes.
Chlamydia, a treatable and curable infection, is typically managed with antibiotics like azithromycin or doxycycline for uncomplicated cases. Repeated infections can occur if sexual partners are untreated or if unprotected sex continues with an infected individual. Newborns with chlamydial eye infection receive azithromycin treatment. After treatment, a 7-day waiting period or correct condom use is advised before resuming sexual activity. Partner notification is crucial to prevent further transmission within sexual networks, emphasizing the importance of prompt diagnosis and treatment (Dlugasch & Story, 2024).
What are the recommended medications to start this specific patient on?
For a patient like Eric Johnson with diagnoses of pneumonia and chlamydia, treatment with doxycycline is a reasonable approach.
Drug Class: Doxycycline is a tetracycline antibiotic.
Generic & Trade Name: The generic name is Doxycycline, and trade names can include Vibramycin, Doryx, Adoxa, and others.
Initial Starting Dose: A common starting dose for adults is 100 mg orally twice a day for both pneumonia and chlamydia.
For Allergies:
Drug Class: Second-generation Antihistamine
Generic & Trade Names: Loratadine (Claritin) or Cetirizine (Zyrtec)
Initial Starting Dose: For Zyrtec take one 10 mg tablet once daily; do not take more than one 10 mg tablet in 24 hours. For Claritin a common adult dosage is 10 mg by mouth once a day.
For High Fever:
Drug Class: Antipyretic and Analgesic
Generic & Trade Names: Acetaminophen (Tylenol)
Initial Starting Dose: may take up to 1000 mg every 6 hours ( 4 times a day), do not exceed 4 gm a day.
Mechanism of Action:
Doxycycline works by inhibiting the growth and spread of bacteria. It does this by interfering with the protein synthesis process in bacterial cells, ultimately preventing their multiplication (Arcangelo, 2022).
Loratadine (Claritin) and Cetirizine (Zyrtec): These are antihistamines that block the action of histamine. These are second generation antihistamines (Arcangelo, 2022).
Acetaminophen (Tylenol): It reduces fever and relieves pain by affecting certain areas of the brain, but its exact mechanism of action is not fully understood.
Side Effects:
Doxycycline can lead to a range of adverse effects. These include gastrointestinal issues like abdominal discomfort, nausea, and diarrhea. Dental problems such as tooth discoloration and enamel issues are also possible, especially with prolonged use. Rare but severe hepatotoxicity may occur, leading to jaundice and irreversible shock. Renal toxicity can manifest as hyperphosphatemia and increased urination and thirst. Photosensitivity reactions may cause skin rashes, and auditory symptoms like tinnitus and hearing loss can occur. Visual disturbances, lightheadedness, dizziness, and headaches are among the central nervous system effects associated with doxycycline use (Arcangelo, 2022).
Loratadine (Claritin) and Cetirizine (Zyrtec): These second-generation antihistamines are generally well-tolerated, with side effects being mild and infrequent. Possible side effects include drowsiness, headache, and dry mouth (Arcangelo, 2022).
Acetaminophen (Tylenol): When used as directed, it is usually well-tolerated. However, excessive use can lead to liver damage, so it’s essential to follow dosing guidelines carefully.
Medication Interactions: Doxycycline can interact with certain medications, including antacids, iron supplements, and other antibiotics, potentially reducing its effectiveness. It’s important to space the timing of these medications apart to avoid interactions.
Non-Pharmacological Interventions: In addition to medication, non-pharmacological interventions for pneumonia may include rest, staying hydrated, and using a cool mist humidifier to ease breathing. For chlamydia, safe sexual practices, such as using condoms, and notifying sexual partners for testing and treatment are important non-pharmacological measures. Return to ED if his symptoms get worse or he experiences allergic reaction. Avoid alcohol and smoking, as they can worsen respiratory symptoms. When experiencing fever, do not use covers and blankets.
References
Arcangelo, V. P. (2022b). Pharmacotherapeutics for advanced practice: A practical approach. Wolters Kluwer.
Cunha, B. A. (2020). Antibiotics essentials. Physicians’ Press.
Dlugasch, L., & Story, L. (2024). Applied Pathophysiology for the advanced practice nurse. Jones & Bartlett Learning.
