Pharmacology (Anti-infective Drugs 3)
In the contemporary medical world, laboratory services are of the essence to the change of treatment from broad spectrum to narrow spectrum medications for individuals that were on empirical therapy. A proof of this statement is a case study involving a 70-year-old man diagnosed with community-acquired pneumonia (CAP) and on broad-spectrum antibiotics. His laboratory results are out, and this necessitates a change in therapy to more suitable agents that will treat his pneumonia effectively. In essence, this paper aims at analyzing this case study to its practical details. Central to the analysis is the determination of the needed drugs’ adjustments given the laboratory findings and ways for monitoring for efficacy and toxicity of patient’s pharmacological profile.
First and most importantly, going by the new laboratory results (eGFR ~40mL/min, serum creatinine of 3.0 mg/dl, and BUN of 50 mg/dl), this patient is subject to changes in the medications he is currently. Primarily, he is a candidate for acute renal failure because his laboratory values are reminiscent to those of an individual with this disease. That is for sure because according to Lerma, and Nissenson, (2012), characteristic of patients with renal failure are features such as increased serum creatinine levels, markedly reduced eGFR and increased BUN levels. Based on the realization that this patient has kidney failure, it is thus important that a healthcare professional adjusts the medication regimen appropriately to suit the patient.
That said, currently, the patient is on a treatment plan entailing the use of broad-spectrum antibiotics (Erythromycin 500mg QID x 7-14 days and Ceftriaxone 1-2g for every 24 hours), which needs to change to suit the patient’s condition. Central to the adjustment of the treatment plan are two alternatives that one can pick for the effective management of this patient. A case in point is the cessation of the two antibiotics and initiation of the patient on a respiratory fluoroquinolone such as levofloxacin (750mg every 48hours). Such an option has the best outcomes in the management of the CAP in persons with comorbidities like renal diseases and thus considered as the first line of treatment (Mandell et al., 2007). Alternatively, one can continue administering the two medications but adjust the dosage. Watkins and Lemonovich, (2011) are of the opinion that in the absence of the respiratory fluoroquinolone, a combination of a macrolide (erythromycin 500mg QID) with a Beta- lactam drug (ceftriaxone 500mg BID or high dose amoxicillin 1g TID) is still effective in treating a CAP patient. Clearly, with such adjustments, one is on course to manage this patient’s CAP effectively.
Lastly, the identification of mechanisms for the monitoring for efficacy and toxicity of this patient’s pharmacological profile is also of prime interest to this discussion. Precisely, following the treatment plan alterations, the patient is currently on either a monotherapy of Levofloxacin 750mg every 48hours or a dual therapy of erythromycin 500mg QID with ceftriaxone 500mg BID or high dose amoxicillin 1g TID. Monitoring of the efficacy and toxicity of this patient’s pharmacological profile entails various strategies that are worth noting. For instance, Levofloxacin’s effectiveness is noticeable through improved clinical response of the patient and cure. Determination of its toxicity is possible through laboratory tests such as liver function tests for the ascertainment of hepatotoxicity, and ECG values for identification of QT prolongation. As for the dual therapy of erythromycin with ceftriaxone or high dose amoxicillin, monitoring of the efficacy is achievable by clinical success (improvement of clinical response). On the contrary, the toxicity is also measurable through observation of laboratory values for the determination of the presence of toxicity (Chisholm-Burns, 2010).
Concisely, this discussion aimed at analyzing a case study involving a 70-year-old man diagnosed with CAP whose treatment plan is subject to change following the realization of he has renal failure based on his laboratory findings. Indeed, the paper has achieved this objective largely. An implication drawn from this discussion is the need for relying on laboratory services for the treatment of diseases such as CAP for this patient. In the absence of such dependence, negative healthcare outcomes such as readmissions are inevitable.
References
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Chisholm-Burns, M. A. (2010). Pharmacotherapy principles & practice. New York: McGraw-Hill.
Lerma, E., & Nissenson, A. (2012). Nephrology secrets (1st ed.). St. Louis, Mo.: Elsevier/Mosby.
Mandell, L., Wunderink, R., Anzueto, A., Bartlett, J., Campbell, G., & Dean, N. et al. (2007). Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clinical Infectious Diseases, 44(Supplement 2), S27-S72. http://dx.doi.org/10.1086/511159
Watkins, R., & Lemonovich, T. (2011). Diagnosis and Management of Community-Acquired Pneumonia in Adults. Am Fam Physician, 83(11), 1299-1306.
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