Question

Case Study Antibiotics

UTI

J.J. is a 26 year old woman who presents to the emergency department with complaints of increased urinary urgency over the past 4 days. She states that she had been diagnosed with urinary tract infection when she was 14 and the symptoms feel the same. A urine sample was sent to the lab for culture and sensitivity and the primary results came back as Gram (-) rods. The final results are pending.

1. What signs and symptoms of a UTI does the patient have?

2. What is the likely bacteria?

3. What would be good antibiotic to use for her UTI?

4. What information would you give to a patient starting on the antibiotic?

Diabetic Foot Ulcer

T.R is a 44 year old male with type 1 DM who presents to the emergency department complaining of pain from an ulcer on the sole of his right foot. He reports having an ulcer in the past, but it healed after he borrowed a cream (unknown by the patient) from his friend. He has been using the same cream on this ulcer for the past week with no relief. He works in construction, so he needs to be on his feet all day, and today he could not take the pain anymore. The ulcer started about 2 weeks ago. He thinks there was a rock in his shoe for an entire work day that started it.

The ulcer was examined. The ulcer was quite extensive. The flesh around the ulcer was red and spreading 5-6 cm. When pressure was applied, there was drainage of foul-smelling fluid.

1. What signs and symptoms support the patient’s diagnosis of infection?

2. Empirically, would you think this is a gram (-), gram (+), or anaerobic infection?

3. What antibiotic would you choose to cover this infection?

4. What information would you give to a patient starting on the antibiotic?

Cellulitis

J.C. is a 19 year old college student who presents to the ED with a new onset “boil” on his right buttock. He noticed some pain and irritation in the right buttock area over the past week, but thought it was due to having slid into second base during a baseball game. The pain gradually increased over the past few days. On examination a large 2cm X 4cm red swollen area over the right buttock, with surrounding redness was noted.

1. Would you suspect gram (-), gram (+), or anaerobic infection?

2. What antibiotic would you choose for this infection?

5 days later J.C. returns to the ED complaining that the pain is worse and now he cannot sit during class. Upon examination of the boil it was noted to have increased in size

3. What bacterial to you know suspect?

4. What antibiotic would you now choose?

Community Acquired Pneumonia

J.T. is a 55 year old man with a three day history of worsening shortness of breath, fevers, chills, right-sided chest pain , and a productive cough. The patient states that his initial symptom of shortness of breath began approximately 1 week ago after delivering mail on an extremely cold winter day.

His physical exam:

VS: BP 155/85 P 127 RR 30 T 101.2

Lungs: labored breathing, decreased breath sounds in the right middle and right lower lung fields.

Sputum culture: many WBC, very few epithelial cells, many Gram (+) cocci

1. What bacterial to you suspect?

2. What antibiotic would you choose?

3. If this patient also had a history of seizure disorder, what class of antibiotics used for community acquired pneumonia could not be used?

4. What information would you give this patient about their antibiotic?

Answer 1

QUESTION 1: UTI

1. SIGNS AND SYMPTOMS OF UTI:

• FREQUENT AND BURNIGNSENSATION DURING URINATION.
• FEVER OR CHILLS.
• LOWER ABDOMINAL PAIN.
• FATIGUE
• CLOUDY AND FOUL-SMELLING URINE.

2. BACTERIA RESPONSIBLE FOR UTI:

• MOST COMMON BACTERIA INVOLVED IN UTI IS ESCHERICHIA COLI( E COLI)
• E COLI COMMONLY FOUND IN THE GASTROINTESTINAL TRACT.
• IT IS A GRAM-NEGATIVE BACTERIA.

3.GOOD ANTIBIOTIC USED FOR TREATMENT OF UTI:

• LEVOFLOXACIN
• CIPROFLOXACIN
• PROLOPRIM
• NALIDIXIC ACID

4.INFORMATION GIVEN TO PATIENT STARTING ON ANTIBIOTIC FOR UTI:

• INFORM THE PATIENT THAT THE APPROPRIATE ANTIBIOTIC WILL BE PRESCRIBED BASED ON THE URINE CULTURE AND SENSITIVITY REPORT.
• RISK OF ADVERSE EFFECTS AND SIDE EFFECTS OF THE ANTIBIOTICS LIKE ABDOMINAL UPSET, RASHES SHOULD BE EXPLAINED.

QUESTION 2:

DIABETIC ULCER FOOT:

1. SIGNS AND SYMPTOMS THAT SUPPORT THE PATIENT'S DIAGNOSIS OF THE INFECTION:

• DISCOLOURATION OF THE ULCER SITE.
• FOUL-SMELLING FLUID DISCHARGE FROM THE ULCER.
• EXTENSIVE NATURE OF ULCER.

2. EMPIRICALLY GRAM NEGATIVE , GRAM POSITIVE OR ANAEROBIC INFECTION:

• DIABETIC FOOT ULCER IS MORE COMMONLY CAUSED BY GRAM POSITIVE BACTERIA.

3.ANTIBIOTICS TO CORRECT THE DIABETIC FOOT ULCER:

• ORAL ANTIBIOTICS OF OFLOXACIN, CIPROFLOXACIN ( EVERY 6 HOURS)OR DOXYCYCLINE (200 MG ONCE DAILY) FOR 14 DAYS IN THE CASE OF MILD AND MODERATE CONDITION OF THE INFECTION.
• IV ANTIBIOTICS ARE INCLUDED IN THE CASE OF SEVERE INFECTION.

4. INFORMATION GIVEN TO PATIENT WHILE STARTING ON ANTIBIOTIC:

• EDUCATING THE PATIENT ABOUT ADVERSE EFFECTS AND SIDE EFFECTS OF THE ANTIBIOTICS PRESCRIBED.
• ADVICE OF REGULAR AND COMPLETION OF THE FULL COURSE OF THE ANTIBIOTIC AS PRESCRIBED.

QUESTION 3: CELLULITIS.

ANSWER 3:

TYPE OF INFECTION:

• CELLULITIS IS CAUSED BY GRAM POSITIVE BACTERIA LIKE STAPHYLOCOCCUS OR GROUP A STREPTOCOCCUS.

ANTIBIOTIC FOR CELLULITIS:

• ORAL ANTIBIOTICS LIKE PENICILLIN, AMOXICILLIN, DOXYCYCLINE FOR 7 TO 14 DAYS.
• CEPHALOSPORINS ARE INDICATED FOR CELLULITIS WITHOUT ABSCESS.

INCREASE IN PAIN AND SIZE OF THE BOIL:

• INDICATES THE SEVERITY OF INFECTION DUE TO STAPHYLOCOCCUS AUREUS BACTERIS.

ANTIBIOTICS TO CHOOSE IN SEVERE CONDITION:

• ANTIBIOTICS LIKE PENICILLIN, AMOXICILLIN, DOXYCYCLINE WITH LOCAL TREATMENT OF DRAINING OF PUS.

QUESTION 4:

COMMUNITY ACQUIRED PNEUMONIA:

ANSWER 4:

1. BACTERIA CAUSING COMMUNITY ACQUIRED PNEUMONIA IN THIS PATIENT:

• STREPTOCOCCUS PNEUMONIAE

2. ANTIBIOTIC FOR COMMUNITY ACQUIRED PNEUMONIA:

• AMOXICILLIN - BROAD SPECTRUM PENICIILIN 1G EVERY 8 HOURS FOR 7 DAYS
• IF ALLERGIC TO PENICILLIN, DOXYCYCLINE -BROAD SPECTRUM TETRACYCLINE 100 mg TWICE FOR 7 DAYS.

3.IF THE PATIENT WITH HISTORY OF SEIZURE DISORDER, ANTIBIOTIC USED:

• CARBAPENEMS ARE USED IF ASSOCIATED WITH SEIZURE DISORDER.

4. INFORMATION TO PATIENT WITH THIS ANTIBIOTIC:

• INFORM ABOUT MILD ADVERSE EFFECTS OF THE DRUGS LIKE VOMITING, DIARRHOEA, SKIN RASH.