A 68-year-old female is brought to the hospital from the acute rehabilitation
facility with complaints of shortness of breath and productive cough for 1
week. She was started on ciprofloxin 3 days ago, but her symptoms have
continued to worsen. Her past medical history includes hypertension,
hypothyroidism. She underwent a right knee replacement 2 weeks ago.
Current medications include lisinopril 10mg, levothyroxine 75mcg,
rivaroxaban 10mg daily and ciprofloxacin 500mg Q12. Her current symptoms
include fever, chills, productive cough with purulent green sputum, and
worsening shortness of breath. She is allergic to morphine. The patient is a
full code.
Current vital signs T 102.6 HR 92. RR 22 BP 128/82. O2 saturation is
96% on 4L of O2
Chest x-ray shows consolidation in the right lower lobe
CBC and CMP are all within normal limits
Decision Point one:
Discontinue the ciprofloxin
Initiate piperacillin/tazobactam 4,5 g IV every 6 hours,
tobramycin 5 mg/kg IV every 24 hours,
and vancomycin. 15 mg/kg every 12 hours
Results of #1:
This patient meets the criteria for hospital acquired pneumonia (HAP) due to
her surgery 2 weeks ago and inpatient stay at the rehabilitation facility. She
is at risk of drug resistant bacteria and MRSA. . A three drug combination for
broad spectrum coverage is indicated until culture and sensitivity report on
her sputum is available and antibiotic deescalation can occur.
The patient’s culture and sensitivity report for sputum and blood culture is
now available. Staph aureus grew from the sputum culture. Utilizing this
information, what adjustments to the patients’ antibiotics would you make
for admission ?
facility with complaints of shortness of breath and productive cough for 1
week. She was started on ciprofloxin 3 days ago, but her symptoms have
continued to worsen. Her past medical history includes hypertension,
hypothyroidism. She underwent a right knee replacement 2 weeks ago.
Current medications include lisinopril 10mg, levothyroxine 75mcg,
rivaroxaban 10mg daily and ciprofloxacin 500mg Q12. Her current symptoms
include fever, chills, productive cough with purulent green sputum, and
worsening shortness of breath. She is allergic to morphine. The patient is a
full code.
Current vital signs T 102.6 HR 92. RR 22 BP 128/82. O2 saturation is
96% on 4L of O2
Chest x-ray shows consolidation in the right lower lobe
CBC and CMP are all within normal limits
Decision Point one:
Discontinue the ciprofloxin
Initiate piperacillin/tazobactam 4,5 g IV every 6 hours,
tobramycin 5 mg/kg IV every 24 hours,
and vancomycin. 15 mg/kg every 12 hours
Results of #1:
This patient meets the criteria for hospital acquired pneumonia (HAP) due to
her surgery 2 weeks ago and inpatient stay at the rehabilitation facility. She
is at risk of drug resistant bacteria and MRSA. . A three drug combination for
broad spectrum coverage is indicated until culture and sensitivity report on
her sputum is available and antibiotic deescalation can occur.
The patient’s culture and sensitivity report for sputum and blood culture is
now available. Staph aureus grew from the sputum culture. Utilizing this
information, what adjustments to the patients’ antibiotics would you make
for admission ?
