hero
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32.A 34-year-old woman who is healthy without underlying medical problems presents to clinic with complaints of temperature up to 101 F and cough with greenish sputum production for 2 days without any dyspnea. Her heart rate is 88/min, and her respiratory rate is 18/min. There is no accessory muscle use or conversational dyspnea, nor are there wheezes, bronchial breath sounds, rales, or egophony over the right lower lung fields. Chest x-ray film reveals a right lower lobe consolidation. A CBC shows a leukocyte count of 13,000/mm3. Which of the following is the most appropriate pharmacotherapy?
a) Amoxicillin
b)Ampicillin-sulbactam
c)Ceftriaxone
d)Erythromycin
e) Erythromycin plus ceftriaxone
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| hero
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?
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| SILVER
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ceftriaxone
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| new_n_lost
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b)Ampicillin-sulbactam
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| paheli
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B
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| hero
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| Ivonne
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D) Community acquired pneumonia without comorbidities--------->outpatient management----------->Erythromycin
Edited by Ivonne on 12/28/07 - 05:41 PM
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| drpswathi
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c
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| Tiff
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Choice A
By the way Ivonne, what is D NAC?
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| jean robert
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A??
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| hero
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The correct answer is D
The first step in the approach to this patient with a community-acquired pneumonia is to categorize her condition according to the American Thoracic Society guidelines (1993), which are based on severity of illness, age, comorbidities, and the need for hospitalization.
This patient does not meet the criteria for hospitalization (one of the following is needed: respiratory rate > 30 breaths/min, room air PaO2< 60 mm Hg, O2 saturation less than 90% on room air, or bilateral or multiple lobes involved), and she is younger than 60 years without any comorbidities.
The most common organisms are Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Haemophilus influenzae, Legionella, and respiratory viruses.
Recommended treatment is with erythromycin or a related macrolide, such as azithromycin or clarithromycin.
Amoxicillin (choice A) does not have broad enough coverage to include the organisms listed above.
Ceftriaxone (choice C) and ampicillin-sulbactam (choice B) are used for hospitalized patients with community-acquired pneumonia.
Erythromycin plus ceftriaxone (choice E) is reserved for patients who are severely ill and hospitalized.
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| shirini2
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D. The first step in the approach to this patient with a community-acquired pneumonia is to categorize her condition.This patient does not meet the criteria for hospitalization (one of the following is needed: respiratory rate > 30 breaths/min, room air PaO2< 60 mm Hg, O2 saturation less than 90% on room air, or bilateral or multiple lobes involved), and she is younger than 60 years without any comorbidities. The most common organisms are Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Haemophilus influenzae, Legionella, and respiratory viruses. Recommended treatment is with erythromycin or a related macrolide, such as azithromycin or clarithromycin.
Amoxicillin (choice A) does not have broad enough coverage to include the organisms listed above.
Ceftriaxone (choice C) and ampicillin-sulbactam (choice B) are used for hospitalized patients with community-acquired pneumonia.
Erythromycin plus ceftriaxone (choice E) is reserved for patients who are severely ill and hospitalized.
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| arlete
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Actually, now a days, quinolones are first choice for this case, because of side effects with erythromycin (mainly GI). But it's the best among the given options, I agree. 
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| hero
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arlete wrote:Actually, now a days, quinolones are first choice for this case, because of side effects with erythromycin (mainly GI). But it's the best among the given options, I agree.
if erythro supposed to work why woud one need cipro?
yatrogenic increase in bacterial resistance 
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| arlete
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hero, erythromycin gives lots of diarrhea. Remember it's used for diabetic gastroparesis?
There was a question in uw for step 2 CK that stated cipro was the first choice. That's what I am sharing.
Personally, I like azithromycin.
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| Ig F
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patient seems to be pretty stable so erythromycin is the best among given options...only if patient would have been verey unstable as well as dyspnea and chest pain....erythromycin and ceftriaxone would be the best option....
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| vaibhavbora
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is it pneumonia due to pseudomonas greenish sputum ,, ?? c)Ceftriaxone
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| arlete
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Why would it be Pseudomonas? 
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| DRFP
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Pseudomonas is not the only one thats green, Beta hemalytic can do colors too,
Yes its D but thats the old pharm, it may be on the test that way too, but in the real world Erythromyicin is not used anymore for these, Levoquin is or some other quinolone.
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| vaibhavbora
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@ arlete ,, why it cannot be pseudomonas ?? green sputum has classic association with pseudomonas ,, 
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