Sun14November0130PM 10

A 68-year-old woman presents with cough, shortness of breath and reduced oral intake. She states that this had been the case for three days and has not improved with oral antibiotics since seeing her GP. Bloods show a CRP of 300, WBC of 15, creatinine of 160 and urea of 9.

A Chest X ray shows left lower zone consolidation.

Observations reveal a respiratory rate of 32, oxygen saturations of 94% on 2 L oxygen, temperature of 38 and a blood pressure of 110/58.

She states that she previously suffered a severe allergy to penicillin.

Which of the following IV antibiotics would be most appropriate?

(Please select 1 option)

Clarithromycin

Ceftriaxone

Levofloxacin Correct

Erythromycin and Gentamicin

Tazocin

Explanation

This patient has chest sepsis and a CURB 65 score of 4 making this a severe pneumonia.

It is important not to forget diastolic BP as criterion in CURB 65 when classifying pneumonias.

Criteria for CURB-65 can be seen below.

CURB-65 Clinical Feature Points

C Confusion 1

U Urea > 7 mmol/L 1

R RR = 30 1

B SBP = 90 mmHg OR DBP = 60 mmHg 1

65 Age > 65 1

CURB-65 Score Risk Group 30-day mortality Management

0-1 1 1.5% Low risk, consider home treatment

2 2 9.2% Probably admission vs close outpatient management

3-5 3 22% Admission

Treatment would be with co-amoxiclav/benzylpenicillin and clarithromycin but in this case, the treatment would be IV Levofloxacin.

Ceftriaxone is a possibility but severe penicillin allergy poses a 10% risk of anaphylaxis.

Clarithromycin is usually used in conjunction with amoxicillin for moderate to severe pneumonia.

Erythromycin and Gentamicin would not cover for chest sepsis adequately.

Tazocin is piperacillin and tazobactam and therefore not appropriate in penicillin allergy.

Answer Statistics

1

19%

2

11%

3

58%

4

8%

5

6%

Times answered: 287