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Is the antibiotic prescribed to my dad appropriate?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Sneha Kannan

Published At February 22, 2016
Reviewed AtJuly 14, 2023

Patient's Query

Hi doctor,

My father is 76 years old. He has been in intensive care unit (ICU) for two days as he was diagnosed with lower respiratory tract infection (LRTI) (CAP - community-acquired pneumonia). Four years back he had tuberculosis (TB). His vitals such as blood pressure (BP), temperature, renal and heart tests are fine. He is not responding to antibiotics and his condition is deteriorating. His saturation has dropped to 82% and put on oxygen. On the third day, he was given Amoxicillin 1000 IV and 5x nebulization and then switched to Piperacillin-tazobactam IV which I have read is for Pseudomonas. Pseudomonas aeruginosa is a commonly acquired hospital bacterium. Doctors admit they have not identified the bacteria yet from the sputum culture and told it will take more than five days to identify the bacteria. Please help.

Hello,

Welcome to icliniq.com. Your father is suffering from acute exacerbation of COPD (chronic obstructive pulmonary disease) with CAP (community-acquired pneumonia) and sepsis. Currently, he is on appropriate antibiotics. But, he needs systemic steroids to cope with the exacerbation along with inhaled steroids. Though his X-ray (attachment removed to protect patient identity) appears normal, CT (computed tomography) thorax is suggestive of bilateral consolidation. Sputum culture should ideally tell us the exact bacteria and sensitive antibiotics for it. Supportive treatment like nutrition, supplemental oxygen, or noninvasive ventilation must be given. There is no worry as other vital organs are functioning normally. But he will take time to recover from this exacerbation. He also had tubercular effusion years back, but now it does not seem to be a relapse of TB (tuberculosis). So, no anti-TB medicines are required at present. Definitely, it is CAP with COPD exacerbation. Even after he gets well, he should take consultation from pulmonologist for inhaler treatment. A sputum culture report should be sought at the earliest or if not available, fiberoptic bronchoscopy can be performed for taking endobronchial sampling for cultures. Steroids should be tapered in appropriate doses. Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Amol Kumar Wasudeorao Diwan
Dr. Amol Kumar Wasudeorao Diwan

Allergy Specialist

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