EMQs in Clinical Medicine.pdf - Peshawar Medical College

Treatment of respiratory infections – answers 47
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A 55-year-old patient with COPD requires regular add-on therapy
after bronchodilators do not control symptoms.
Oral aminophylline taken before going to bed may be particularly helpful
for patients complaining of symptoms in the early hours of the morning.
Aminophylline should be used with care because it has a narrow
therapeutic index. Signs of toxicity include nausea, vomiting and
cardiac arrhythmias.
19 Treatment of respiratory infections
Answers: H E M K C
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Standard therapy for community-acquired pneumococcal pneumonia
not requiring hospital admission.
Oral erythromycin can be prescribed as an alternative if the patient is
allergic to penicillin, or in combination with amoxicillin if an atypical
organism is suspected.
A 35-year-old patient on the ward admitted to hospital 10 days ago
presents with severe pneumonia.
This infection is hospital acquired and therefore the range of pathogens
is likely to be different from those causing community-acquired
pneumonia. Such pathogens include Gram-negative aerobes, e.g.
Pseudomonas spp., and are often multiply antibiotic resistant. Thirdgeneration
cephalosporins, e.g. ceftazidime, have some anti-pseudomonal
activity and can prove effective in these circumstances.
A 40-year-old builder presents with a severe community-acquired
pneumonia. Atypical pathogens are suspected.
This is standard therapy for a severe community-acquired pneumonia.
Rifampicin can be added empirically if there is a high clinical suspicion
of legionella infection.
A 22-year-old human immunodeficiency virus (HIV)-positive individual
on anti-retroviral therapy presents with Pneumocystis carinii pneumonia.
Treatment of choice is high-dose co-trimoxazole delivered intravenously
for 2–3 weeks. Intravenous pentamidine may be used if co-trimoxazole is
contraindicated or not tolerated. Corticosteroids are often used as an
adjunct to treatment if there is hypoxaemia.
A 19-year-old man contracts pneumonia with symptoms of headache,
fever and dry cough. Serology shows evidence of chlamydia infection.
Chlamydial pneumonia often presents with a biphasic illness: upper
respiratory tract symptoms precede the pneumonia. Diagnosis is usually
made retrospectively. Tetracycline is the treatment of choice.