Michelle

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.