What to do if pneumonia persists in elderly male with COPD?

Question

Hi doctor,

My father is 76 years old. He has been in the 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, and renal and heart tests, are fine. He is not responding to antibiotics, and his condition is deteriorating. His saturation has dropped to 82%, and he was 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 yet identified the bacteria from the sputum culture and are told it will take more than five days to identify the bacteria.

Please help.

Answer 1

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 as soon as possible, or if it is not available, fiberoptic bronchoscopy can be performed to take endobronchial sampling for cultures. Steroids should be tapered in appropriate doses.

I hope this helps.

Thank you.