chbare Posted October 30, 2011 Author Posted October 30, 2011 Why are we going with doxycycline? Is there enough evidence for us to empirically treat with a tetracycline? Your antimicrobial options include: Zithromax, ceftriaxone, Cipro, Bactrim DS, Augmentin, Levaquin, Amoxil and Ancef. Two hours after administering a gram of Tylenol and oral fluids, the patient reports that he is feeling much better. His fever has resolved and he is no longer tachycardic. What do you do? Labs will take at least two days to run.
DFIB Posted October 30, 2011 Posted October 30, 2011 (edited) It's good to see you blokes wanting to dish out paracetamol (tylenol) but you have to give it at much higher dosages for it to be effective. 500mg is only one tablet (the recommended dosage is 2-4) and there is good evidence that 20mg/kg or 1500mg is very effective. I already agreed to your dose in a prior post Why are we going with doxycycline? Is there enough evidence for us to empirically treat with a tetracycline? Your antimicrobial options include: Zithromax, ceftriaxone, Cipro, Bactrim DS, Augmentin, Levaquin, Amoxil and Ancef. Two hours after administering a gram of Tylenol and oral fluids, the patient reports that he is feeling much better. His fever has resolved and he is no longer tachycardic. What do you do? Labs will take at least two days to run. Doxicycline is the drug of choice for the gram negatives I suspect he has. I would continue the course of treatment till labs come back. Patient is to return for consult if condition changes or worsens. I am way, way outside my scope of practice on this one and I am pretty incomfortable taking the court with you guys. Please be gentle. Edited October 30, 2011 by DFIB
chbare Posted October 30, 2011 Author Posted October 30, 2011 What Gram negative is suspected? What is a common cause of fever? Is is often bacterial or viral?
txladymedic Posted October 30, 2011 Posted October 30, 2011 Depending on how long this has been going on I might be comfortable just sending him home with ORS/fluids, recommendations to tank up on fluids and continue with tylenol prn for fever, recheck in the AM or sooner if the symptoms change or worsen. If I am going to do an antibiotic, I personally like Augmentin to start and if there is no improvement then work my way up the antibiotic food chain. But I am not opposed to considering others. Oh yea...does he have a rash?
chbare Posted October 30, 2011 Author Posted October 30, 2011 No rash. Why Augmentin? What does it cover, what do you suspect?
Kiwiology Posted October 30, 2011 Posted October 30, 2011 (edited) I already agreed to your dose in a prior post Yes I was putting it out there as rationale for the rest of us Why are we going with doxycycline? Is there enough evidence for us to empirically treat with a tetracycline? Your antimicrobial options include: Zithromax, ceftriaxone, Cipro, Bactrim DS, Augmentin, Levaquin, Amoxil and Ancef. I will be honest, my knowledge of the various types of bacteria and antibiotics is poor. All I know about tetracycline antibiotics is that the Defense Force uses them and not to give somebody who is on them methoxyflurane because it can cause a significant rise in fluoride ions. So I had a look see in the book and found the following Erythromycin or another macrolide (Taylor, R (2001) Manual of Family Practice; 2nd ed, Lippincott, Williams & Wilkins, Baltimore MD) Erythromycin or alternatively doxycycline or a third generation ceflosporin (ceftriaxone) (Goroll, A., and Mulley, A. (2000) Primary Care Medicine: Office Evaluation and Management of the Adult Patient; 4th ed, Lippincott, Williams & Wilkins, Baltimore MD) Macrolide or doxycycline (Fauci, A., Hauser, S., Jameson, L., Kasper, D., Longo, D., & Loscalzo, J. (2008). Harrison's Principles of Internal Medicine; 17th ed. Columbus, OH: McGraw-Hill.) Macrolide or doxycycline (Barkin, R., Mayhen, S., Rosen, P., Shalder, J., & Wolfe, R. (2007). Rosen and Barkin's 5-Minute Emergency Medicine Consult. Baltimore, MD: Lippincott Williams and Wilkins.) Advanced generation macrolide (American Thoracic Society. (2001). Guidelines for the Management of Adults with Community-acquired Pneumonia: Diagnosis, Assessment of Severity, Antimicrobial Therapy, and Prevention. American Journal Of Respiratory And Critical Care Medicine, 1731-1754) Amoxicillin or doxycycline (British Thoracic Society, Guidelines for the Management of Community Acquired Pneumonia in Adults Update 2009: A Quick Reference Guide) Two hours after administering a gram of Tylenol and oral fluids, the patient reports that he is feeling much better. His fever has resolved and he is no longer tachycardic. What do you do? Labs will take at least two days to run. - Discharge back to container - Oral fluids and paracetamol prn not to exceed 1,500mg q4h - No macrolides in the list provided of what we have so let's keep him on doxycycline as appears preferred over ceftriaxone - Review mane Edited October 30, 2011 by kiwimedic
DFIB Posted October 30, 2011 Posted October 30, 2011 What Gram negative is suspected? What is a common cause of fever? Is is often bacterial or viral? I was thinking of Rickettsiae. I don’t know which the more common cause of fever Afghanistan is. With no flu vaccinations possibly viral fevers are more common. But with US aid they may be better vaccinated than Americans. I would suspect they have a pretty good dose of both.
chbare Posted October 30, 2011 Author Posted October 30, 2011 Zithromax is a macrolide. Do we have good evidence to begin anti microbial therapy however? He is sent home with APAP and push fluids instructions. A tentative diagnosis of viral syndrome is made. Unfortunately, he returns 48 hours later with the same symptoms. He also complains of chest tightness and you auscultate scattered wheezes. He is tachycardic, complains of generalised myalgia and a headache. His temperature is 102 F. Labs are back: He has leukocytosis and mild anaemia.
DFIB Posted October 30, 2011 Posted October 30, 2011 Does he have jaundice? Hepatomegaly? Blood in urine? Is malaria endemic to this area? On another vector. Does he work with chemicals? Could he have a toxicity causing fever? Any word on the febrile antibody test yet?
chbare Posted October 30, 2011 Author Posted October 30, 2011 No. Yes, but everything's frozen and Mosquitos are not out and about. He does IT work. Febrile antibodies are not going to be available. A new chest X-ray shows the development of a small right sided pleural effusion.
Recommended Posts