Which antibiotic regimen is most appropriate for this hospitalization?

Which antibiotic regimen is most appropriate for this hospitalization?

1. Sulfamethoxazole/trimethoprim every 12 hours
2. Amoxicillin/clavulanate every 12 hours
3. Ceftriaxone plus azithromycin every 24 hours
4. Piperacillin/tazobactam every 8 hours, levofloxacin every 24 hours and vancomycin every 12 hours

• Hospital Course
  • During hospitalization, he receives the following treatment:
    • Nebulized albuterol/ipratropium every 4 hours as needed
    • Prednisone 60 mg daily by mouth
    • 1 gm IV ceftriaxone plus 500 mg oral azithromycin daily
    • Oxygen to maintain PO2 > 60 mmHg

• Preparation for discharge
  • Over 3 days, JS has significantly improved and has weaned back to his home oxygen regimen.
  • He is taking the albuterol/ipratropium nebulized treatments every 6 hours, and is ready to switch back to bronchodilators via inhaler device.
  • Along with antibiotics for a total of 7 days, you need to determine the dose and duration of treatment for oral corticosteroids.

Which corticosteroid regimen would be recommended in this situation?

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1. Prednisone 40 mg daily x 5 days then stop
2. Prednisone 40 mg daily x 14 days then stop
3.  Prednisone 40 mg daily x 21 days then stop
4. Prednisone 40 mg daily x 10 days half the dose every 10 days for a total of 42 days

• Preparing for discharge
  • In completing the medication reconciliation forms, you see that JS had a complex medication regimen upon admission
  • It is clear, during discussions with him, that he is unable to comply with this expensive, complex and potentially unnecessary regimen.

• Medications on admission
  • Lisinopril 20 mg twice daily
  • Metoprolol 50 mg twice daily
  • Spironolactone 25 mg daily
  • Furosemide 40 mg daily
  • Salmeterol/fluticasone 50/500 dry powdered inhaler (DPI) one puff inhaled twice daily
  • Tiotropium DPI one cap inhaled daily
  • Albuterol/ipratropium metered dose inhaler (MDI) or solution for nebulization every 6 hours as needed
  • Levalbuterol MDI two puffs every 4 to 6 hours as needed

Which of the following principles of medication management should be considered when evaluating his discharge medications?

1. Cost of medications
2. Therapeutic duplication
3. Compliance with complex regimen
4. All of the above

Discharge Medications

• Streamline regimen
  • No need for levalbuterol
  • Continue salmeterol/fluticasone 50/500 DPI and/or tiotropium DPI
  • Short-acting bronchodilator MDI as needed
• Patient given pneumococcal vaccine prior to discharge