Prescribing in Community-Acquired Pneumonia, Case Study Example

Over the past decade, a variety of treatment options have become available in combating Community acquired pneumonia. There are increasing concerns over the upsurge of pathogen resistance in relation to antibiotic therapy. The most important goals in pharmacotherapy for community acquired pneumonia include elimination of the causative agents, resolve the signs and symptoms of the disease, minimize and prevent hospitalization and the prevention of subsequent re-infection. Choosing the appropriate medication should also be based on the patient’s profile (i.e. lifestyle, allergy/adverse reactions), possible drug reactions and most importantly, cost-effectiveness.

In the case of Juanita Gonzales, initial review should include assessment of risk factors for mortality. Risk factors may be derived using age, gender, co-morbidities and laboratory data (Fine et. al., 1997). Since no co-morbidities are mentioned, Juanita can be classified as a low-risk patient that can receive treatment on an outpatient basis. In the guidelines published by the Infectious Disease Society America, antibiotic therapy for community acquired pneumonia includes the use of doxycycline, a macrolide or an antipneumococcal fluoroquinolone. These drugs are recommended as they target the most likely causative pathogens which include S. Pneumoniae, M. Pneumoniae and C. Pneumoniae (Bartlett & Dowell, 2000). However, these recommendations differ from the recommendations by the CDC as the latter suggests that treating these organisms is unnecessary as they are not common. The CDC recommends macrolides, doxycycline and oral beta-lactam as the initial treatment for community acquired pneumonia and emphasize that the use of fluoroquinolones should be reserved later on (Heffelfinger, 2000).

In Mrs. Juanita Gonzales’ case, Azithromycin can be prescribed as first-line treatment as it has a broad coverage of the most probable causative agents in community acquired pneumonia. Azithromycin falls under the category of macrolides and compared with other antibiotics, Azithromycin cause less gastrointestinal disturbances. It also has the makings for ensuring good compliance to treatment regime because of its reduced dosing frequency. Furthermore, Azithromycin is one of the most cost-effective options, costing $40-$60 per course (Fish, 2002).

Two alternate medications that can be prescribed for Ms. Gonzales include Clarithromycin and Doxycycline. Clarithromycin is another drug recommended in treating community acquired pneumonia with no associated complications. Clarithromycin is very much similar to Erythromycin in terms of efficacy in treating mild to moderate community acquired pneumonia but this option is better for Ms. Gonzales due to lesser effects on the gastrointestinal system. However, Clarithromycin cause mor gastrointestinal symptoms when compared to Azithromycin, thus making the drug a secondary choice. Since Ms. Gonzales works variable hours, the frequency of taking Clarithromycin can aid in compliance to treatment regimen as Clarithromycin is often prescribed either once or twice daily. With regards to cost, Clarithromycin is estimated to cost $96 per course (Fish, 2002).

Doxycycline is another alternative drug for individuals who are unable to tolerate macrolides or penicillins. Doxycycline is another broad-spectrum antibiotic that provides good coverage against both typical and uncommon pathogens, except for highly-resistant strains. In terms of cost, Doxycycline is in the mid-range level, costing about $102 per course.

Patient education is also essential to establish the importance of antibiotic therapy. Crucial patient teachings can include: (1) compliance to treatment regime, particularly adhering dosage and duration of treatment, (2) eating small meals prior to taking antibiotics to lessen gastrointestinal disturbances, (3) possible interactions with food and other drugs and, (4) adherence to follow-up and evaluation.

References

Bartlett J.G & Dowell, S.F. (2000) Practice Guidelines for the Management of Community Acquired Pneumonia in Adults. Clin Infect Dis 31:347-82.

Fine, M.J et al. (1997) A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 336:243.

Fish, D. (2002) Pneumonia. In: Pharmacotherapy self-assessment program. 4th ed. Kansas City: American College of Clinical Pharmacy.

Heffelfinger, J.D et al. (2000) Management of community-acquired pneumonia in the era of pneumococcal resistance. A report of the drug-resistant Streptococcus pneumoniae therapeutic working group. Arch Intern Med 160:1399-1408.

Mandell, L.A et al. (2007, March) Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 44 Suppl 2:S27-72.