Usage of antibiotics in the ward:
|
DETAILS
|
HISTORY/PHY EX/Ix
|
DIAGNOSIS
|
ANTIBIOTIC
|
DISCUSSION |
1
|
56
y/o / M
k/c/o
DM
|
· Fever for 8
days with productive cough.
·Bibasal crepitations heard.
|
Community
acquired pneumonia
|
· IV Augmentin
1.2g TDS
·T.
Azithromycin 500mg OD
|
Augmentin is usually used forB-lactamase producing strains of Strep pneu, H. infl, Moraxella C. Azithromycin (macrolide) used for CAP |
2
|
40
y/o/ F
k/c/o
BA
|
· SOB for 2 days, with cough and wheezing
· Ronchi heard
bilaterally
|
AEBA
secondary to URTI
|
· C. Amoxycillin
500mg TDS for 1 week
|
Amoxycillin is used for mild to moderate LRTI from Strep pneu, Staph, H. Influenzae. |
3
|
51y/o
/ M
k/c/o
COPD, HT, gout
|
· SOB for 1 day,
with cough
· Crepitations
heard bibasally
|
AECOAD
secondary to CAP
|
· IV Augmentin
1.2g TDS
·T.
Azithromycin 500mg OD
|
|
4
|
83
y/o /M
k/c/o
HT
|
· Confusion and
disorientation of sudden onset
· UFEME: UTI
picture
|
Acute
delirium secondary to UTI
|
· IV Cefuroxime
750mg TDS
·IV
Ciprofloxacin 200mg BD
|
Cefuroxime is 2nd gen cephalosporin (gram -ve). Used for UTI. Ciprofloxacin targets gram -ve and +ve |
5
|
55
y/o/ M
k/c/o
DM
|
· Jaundice for 6
days, high-grade fever for 2 months
· Leptospira ag:
+ve
· Mycoplasma pneumonia:
+ve
|
Leptospirosis
infection with underlying lung infection
|
· T. Doxycycline
100mg BD
· IV Ceftriaxone
1g OD
|
Doxycycline is used for mycoplasma pneumoniae infection. Ceftriaxone is 3rd gen cephalosporin, mostly gram -ve B-lactamase bacilli |
6
|
51
y/o/ F
k/c/o
BA
|
· SOB of sudden
onset, with productive cough.
· Bibasal
crepitations
|
APO
secondary to NSTEMI with CAP
|
· T. EES 800mg
BD
· T. Augmentin
625mg BD
|
|
7
|
58y/o/
M
k/c/o
COPD
|
· SOB for 2
days, with productive cough. No fever.
· Bibasal
crepitations heard.
|
AECOAD
secondary to CAP
|
· IV Augmentin
1.2g TDS
· T. EES 800mg
BD
· T.
Ciprofloxacin 500mg BD
|
Patient's antibiotics were changed to Ciprofloxacin to prevent development of antibiotic-resistant organisms. |
8
|
50
y/o / M
k/c/o
stage 4 lung cancer
|
· Fever, cough,
SOB for 2 days
· Crepitations
heard with reduced breath sounds over right lung zones.
|
Pleural
effusion secondary to lung carcinoma with underlying CAP
|
· IV Cefepime 2g
OD
|
Cefepime is 4th gen cephalosporin. Susceptible organisms include E. coli, H. influenzae, Klebsiella, Staph aureus, Strep pyogenes. Used for CAP and UTI. |
9
|
49
y/o/ F
k/c/o
bronchiectasis
|
· SOB for 2
days, fever for 5 days with productive cough
· Coarse crepitations
heard
|
Acute
infective exacerbation of bronchiectasis secondary to CAP
|
· IV Cefepime 2g
BD
|
|
10
|
57
y/o/ F
k/c/o
DM, HT, CKD, CCF, Thyrotoxicosis
|
· SOB for 4 days
with noisy breathing for 2 months. Fever=39 deg.
· Intubated and
ventilated in the ward.
· UFEME: UTI
picture
|
Sepsis
secondary to CAP/UTI
|
· IV Augmentin
1.2g TDS
·T.
Azithromycin 500mg OD
|
|
In the wards, most of the patients diagnosed with community acquired pneumonia will usually be given a combination of broad-spectrum antibiotic of IV Augmentin and T. Azithromycin to cover both gram negative and gram positive organisms. In a case of UTI, usually cephalosporin-based antibiotics such as Cefuroxime or Ceftriaxone will be prescribed as most UTI organisms are gram negatives. 4th Generation cephalosporins such as Cefepime are prescribed in cases whereby both gram negative as well as gram positive organisms are suspected in an immunocompromised or immunosupressed patient. I feel that most of the antibiotics prescribed in the wards are appropriate with the presenting complaint and provisional diagnosis of the patient. However, there exists certain cases whereby antibiotics should not be prescribed. For instance, I feel that patient (2) should not be prescribed antibiotics as her AEBA is most likely exacerbated by the URTI that she had previously which is usually viral in origin. She did not even present with fever. Hence, I feel that this particular patient was wrongly prescribed antibiotics.
