Pneumonia Diagnostics and Pharmacological Treatment

Introduction: Etiology of the Diagnosis

Pneumonia is a highly prevalent disease that can be caused by different pathogens. The most common potential cause might be Streptococcus pneumonia or any type of Gram-positive bacteria that can be acquired from the hospital environment or community (Cilloniz, Martin-Loeches, Garcia-Vidal, Jose, & Torres, 2016). Thus, it can incur due to intracellular pathogens such as Legionella pneumophila and Mycoplasma pneumoniae (Cilloniz et al., 2016). Additionally, pneumonia may be caused by co-pathogens that are accompanied by influenza such as staph aureus or have viral nature (Woo & Robinson, 2016). Thus, they are not triggers in this case due to differences in symptomatology.

Pathophysiology of the Diagnosis

Generally speaking, pneumonia incurs due to the invasion of the lung parenchyma by different pathogens while the defense mechanism of the host organism is weak. In the context of the presented case, Bacterial Pneumonia appears due to the changes in the defense mechanism that can be caused by immunological issues or viral infection (Woo & Robinson, 2016). Thus, the viruses can be acquired in the hospital environment or from the community using aspiration or inhalation of the pathogen (Cilloniz et al., 2016). A combination of these aspects explains its high prevalence among adults.

Epidemiology of the Disease

Bacterial or community-acquired pneumonia (CAP) is a disease with a high worldwide prevalence with the occurrence rate of 2.7 to 10 per 1000 people (Pletz, Rohde, Welte, Kolditz, &Ott, 2016). It is accompanied by chills, fatigue, and cough. This type of pneumonia is commonly observed among adults of the age of 24-65+, and in 2014, it was defined as the fourth cause of mortality in the United States of America (Cilloniz et al., 2016). For example, 257,000 adults at the age of 45-64 years old were diagnosed with pneumonia in 2010 while 621,000 adults over 65 were also hospitalized with this condition (Broulette, Yu, Pyeson, Iwasaki, & Sato, 2013).

Thus, this disease is also highly prevalent among children while killing 920,136 of them in 2015 (Cilloniz et al., 2016). In this instance, the major risk factors pertain to the age (older than 65 or younger than 2), hospitalization, smoking, and different chronic diseases. To prevent the occurrence of this condition, it is reasonable to avoid communication with infected individuals and have a healthy lifestyle.

Diagnostic Criteria

There are a plethora of factors that help identify pneumonia. In the first place, physical examination such as pulse, respiration rate, and temperature are the first indicators of any disease. In turn, having a conversation with a patient about his/her condition such as shortness of breath, malaise, and presence of sputum will be positive indicators of pneumonia (Woo & Robinson, 2016). Medical history would help discover whether, in the past, the cases of pneumonia or antibiotic usage took place or the presence of commodities. In turn, chest radiography (x-ray) should be used for all patients suspected with CAP, and it should be repeated if a patient shows negative dynamics (Gupta et al., 2012).

In the case of complications, CT has to be performed(Gupta et al., 2012). All patients have to pass blood tests to assess their blood cultures and monitor Leukocytosis and blood glucose(Gupta et al., 2012). Sputum Gram stain has to be collected for the analysis from all hospitalized patients with CAP(Gupta et al., 2012). In the case of the severe progression of the disease, Legionella urinary sample will be required(Gupta et al., 2012). Electrolyte, urea, and liver function assessments also have to be performed(Gupta et al., 2012). A combination of these factors helps select the most appropriate treatment and prevent CAP from developing.

Goals of the Drug Therapy

The major aims of drug therapy are to diminish the issues with breathing and return to the initial respiratory status (Woo & Robinson, 2016). Another objective is to diminish fever and return the body temperature to the normal state within 2-4 days (Woo & Robinson, 2016). Another essential goal is the fact that the treatment should cause the resolution of Leukocytosis by the fourth day since the start of the treatment. In turn, the chest x-ray is expected to return to its normal condition within 4-6 weeks after the beginning of taking the prescribed medication (Woo & Robinson, 2016). Overall, these goals will return the organism of R.R.to normal functioning.

Prescription of Medication

  • PRIMARY CARE CLINIC
  • KEISER UNIVERSITY SCHOOL OF NURSING
  • Date: 9/21/17
  • Patient Name: R.R. Birthdate: 2/24/59
  • Name of Medication: Levofloxacin 750mg
  • SIG: One tablet once a day orally.
  • Take with or without food for 7 days
  • # dispensed: 7 Refills: None
  • Signature: Margarita Jones, RN, FNP Student Keiser University

The Action Mechanism of the Medication

Levofloxacin focuses on killing the bacteria that cause an infection by inhibiting bacterial type II topoisomerases, topoisomerase IV, and DNA gyrase (U.S. National Library of Medicine, 2017). Its action mechanism is similar to that of other fluoroquinolones as the medicine breaks a bacterial chromosome, supercoiling, and resealing (U.S. National Library of Medicine, 2017). It also blocks the reduplication of DNA and transcription of data from DNA to RNA. All these actions result in the bacterias inability to reduplicate and contributed to the gradual recovery.

Watch out, Effectiveness of the Medication, and Education

At the moment, levofloxacin is one of the most efficient respiratory fluoroquinolones as its short-term treatment (5-7 days) could be compared to 7-9 days treatment with analogous medication (Bennet, Dolin, &Blaser, 2015). All antibiotics that belong to the third generation of fluoroquinolones are proven to have positive effects on the medical condition of patients with 100% being cured of CAP (Bennet et al., 2015).

For this reason, levofloxacin could be considered one of the most effective medicines to treat pneumonia, chronic bronchitis, bacterial sinusitis, urinary tract infections, and other diseases caused by bacteria. However, different adverse effects could be observed in patients using levofloxacin. These include allergic reactions in the form of fever and rash, abdominal pain, nausea, fatigue, issues with the digestive system, diarrhea, insomnia, depression, pain, fainting, and liver injury (U.S. National Library of Medicine, 2017).

The medicine could also interact with other medications such as warfarin, sucralfate (reduces absorption), probenecid, multivitamins (if they are taken several hours before levofloxacin), corticosteroids, insulin, theophylline, ibuprofen, and other NSAIDs (U.S. National Library of Medicine, 2017). To avoid these consequences, a patient has to inform a doctor about any reactions immediately. In turn, R.R. has to have a blood test scheduled four days after the start of the treatment and subsequent evaluation seven weeks after the start of the treatment (McDonald, Jayathissa, &Leadbetter, 2015).

Repeated x-ray has to be performed in the case of negative dynamics within 6-12 weeks (McDonald et al., 2015). In this instance, patient education should cover a general description of pneumonia and its types, prescription of levofloxacin, its possible adverse effects and interactions with other medications, the importance of hydration and rest, possible symptoms of the worsening condition (no improvement, fever, chills, fast heartbeat, and issues with breathing), and actual improvement within 48-72 hours (if the instructions are followed) (Woo & Robinson, 2016). Covering these concepts will help consult a doctor promptly and avoid complications.

Conclusion: Clinical Guideline

The proposed treatment is selected since it complies with clinical guidelines of the Infectious Disease Society of America (IDSA) and American Thoracic Society (ATS) which recommend using third-generation fluoroquinolones in similar cases (Amitabh et al., 2012). It supports the idea that the patients with comorbidities have to take respiratory fluoroquinolone to kill the bacteria causing the disease and promote recovery (Amitabh et al., 2012). In the end, using this medical intervention is proven by evidence-based practices and can help the patient recover rapidly.

References

Amitabh, V., Singhal, I., Kumar, S., Patel, N., Rizvi, Y., & Mishra, P. (2012). Efficacy and safety of oral gemifloxacin for the empirical treatment of pneumonia. Lung India, 29(3), 248-253.

Bennet, J., Dolin, R., &Blaser, M. (2015). Principles and practice of infectious diseases. Philadelphia, PA: Elsevier Saunders.

Broulette, J., Yu, H., Pyeson, P., Iwasaki, K., & Sato, R. (2013). The incidence rate and economic burden of community-acquired pneumonia in a working-age population. American Health & Drug Benefits, 6(8), 494-503.

Cilloniz, C., Martin-Loeches, I., Garcia-Vidal, C., Jose, A., & Torres. A. (2016). Microbial etiology of pneumonia: Epidemiology, diagnosis, and resistance patterns. International Journal of Molecular Sciences, 17(12), 2120.

Gupta, D., Agarwal, R., Aggardwal, A., Singh, N., Mishra, N., Khilnani, G., … Jindal, S. (2012). Guidelines for diagnosis and management of community- and hospital-acquired pneumonia in pneumonia in adults: Joint ICS/NCCP(I) recommendations. Lung India, 19(2), 27-62.

McDonald, C., Jayathissa, S., &Leadbetter, M. (2015). Is post-pneumonia chest X-ray for lung malignancy useful? Results of an audit of current practice. International Medicine Journal, 45(3), 329-334.

Pletz, M., Rohde, G., Welte, T., Kolditz, T., &Ott, S. (2016). Advances in the prevention, management, and treatment of community-acquired pneumonia. F1000 Research, 1(1), 5-10.

U.S. National Library of Medicine. (2017). Levofloxacin. Web.

Woo, T., & Robinson, M. (2016). Pharmacotherapeutics for advanced practice nurse practitioners. Philadelphia, PA: F.A. Davis Company.