Infectious Disease Drugs And Treatment Program
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Original work, answer the (3) questions below that go with the case study (this is NOT a paper just respond to the questions and cite if needed)
Case Study: Infectious Disease Drugs – Antibiotic
JT is a 29-year-old quadriplegic male with multiple chronic decubitus ulcers who presents to the emergency department with increasing malodorous, purulent drainage from his sacral wounds that started a few days ago. Additionally, he reports a 1-week history of increasing generalized pain and fatigue. JT resides in a long-term acute care facility and has limited mobility.
Past Medical History:
Motor vehicle accident (5 years ago)
Quadriplegia
Type II diabetes mellitus
Peripheral vascular disease
Allergies:
Vancomycin – Red Man’s Syndrome
Vitals in the ED:
Blood pressure: 110/72 mmHg; Pulse: 105 bpm; Respiratory rate: 22/min; Temperature: 101.2
Height: 5’9”; Weight: 72 kg
Imaging: Pending
Pertinent Labs (All others are within normal limits):
Values in the ED
Normal range
Basic Metabolic Panel
CREATININE LEVEL (CREAT)
2.5
0.5-1.0 mg/dL
GLUCOSE LEVEL (GLUC)
152
73-110 mg/dL
A1c
6.9
4.2-6.3%
Inflammatory Markers
ESR
78
0-22 mm/hr
CRP
16
<10 mg/L
Complete Blood Count
WBC
18
4.5-11 cells/mcL
RBC
5
4.32-5.72 million cells/mcL
Platelet
422
150,000-450,000/mcL
JT is experiencing a sudden decrease in his urine output and his SCr has more than doubled since admission.
1. Which antibiotics (vancomycin, piperacillin/tazobactam, tobramycin) will be impacted by this new onset renal impairment?
The microbiology laboratory finally reports the identified organisms and antimicrobial susceptibilities. Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus are identified. Renal function has now improved back to baseline and JT is clinically stable.
2. What are the intravenous antibiotic options for treatment of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa?
3. Since the patient is now clinically improving, you would like to continue piperacillin/tazobactam. However, you notice that the piperacillin/tazobactam MIC is high (at the clinical breakpoint) for Pseudomonas aeruginosa.
a. What does the MIC mean? Minimum inhibitory concentration (MIC): The lowest concentration of antibiotic that results in no visible growth.
a. Describe the pharmacodynamic target for piperacillin/tazobactam that is associated with optimal activity.
a. What dosing/administration strategies could you use to optimize the activity of piperacillin/tazobactam?
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