Eric Johnson is a 21-year-old Caucasian male in his senior year of college. The patient has a history of seasonal allergies. He does not remember what his allergist told him to take for his allergies in the past. He wants to know what he can take. He presents to the clinic today with complaints of a stuffy nose, shortness of breath, a fever TMAX 102 at home, and a productive cough. He also notes that over the past few months, he has also noticed a watery discharge and burning when he urinates. He does admit to having unprotected intercourse last month. He undergoes rapid testing and a chest x-ray while in the clinic. His diagnoses are pneumonia, chlamydia, and seasonal allergies.
Clinic Vital Signs: BP 125/75, HR 116, Temp 102.5, O2 94%. He has no known drug allergies.
Q1. What are the recommended medications to start this specific patient on? Please provide the drug class, generic & trade name, and the initial starting dose.
Q2. Please discuss the mechanism of action of each of the drugs you listed.
Q3. Please discuss the side effect profile of each medication you listed.
Q4. Are there any interactions between any of the medications you prescribed?
Q5. What other non-pharmacological interventions would be suggested?
PNA is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus, causing symptoms such as cough with phlegm, fever, chills, and difficulty breathing (Eshwara et al 2020). It can cause fever as the body’s natural response to infection. When the body detects the presence of infectious agents such as bacteria, viruses, or fungi in the lungs, the immune system responds by raising the body’s temperature. Fever helps to create an environment that is less hospitable to pathogens, and it also activates the body’s immune response to fight the infection (Eshwara et al 2020). A productive cough, which produces phlegm or mucus, is a common symptom of pneumonia. When the air sacs in the lungs become inflamed and filled with fluid or pus, the body attempts to clear the infection and debris by coughing. Shortness of breath, or dyspnea, can occur in pneumonia due to the inflammation and infection affecting the air sacs in the lungs (Eshwara et al 2020). As the infection progresses, the ability of the inflamed lung tissue to exchange oxygen and carbon dioxide becomes compromised, leading to difficulty in breathing. PNA is diagnosed by physical examination, chest x-ray, blood tests can determine the type of infection and the severity, sputum test, CT and ABGs may be performed to assess the extent of the infection and its impact on the lung function. Bacterial PNA is typically has more sudden onset of symptoms, high fever, productive cough with yellow, green, or bloody mucus, rapid breathing and heart rate, chest pain when breathing or coughing (Eshwara et al 2020). Viral PNA may appear more gradually, fever is lower in comparison to bacterial, dry cough, although some may produce a small amount of mucus, rapid breathing, and heart rate. It may improve with antiviral medications. Fungal pneumonia with antifungal medications (Eshwara et al 2020). Given our patients case, post chest x-ray and him experiencing, SOB, productive cough and a temp of 102.5, it is most likely bacterial pneumoncough,d needs to be treated with antibiotics.
Chlamydia is a common sexually transmitted infection (STI) caused by the bacterium Chlamydia trachomatis. It can be transmitted through unprotected sexual contact, including vaginal, anal, or oral sex with an infected individual. It often does not cause symptoms, especially in the early stages, which can make it easy to spread unknowingly (Geisler et al., 2022). When symptoms do occur, they can include pain during urination, genital discharge, and in women, abnormal vaginal bleeding. If left untreated, chlamydia can lead to serious health problems such as pelvic inflammatory disease. (PID) in women, which can cause infertility, and in men, it can lead to epididymitis, which is an inflammation of the tube that carries sperm (Geisler et al., 2022). Chlamydia can be diagnosed through laboratory tests on a urine sample or swab from the infected area. It can usually be effectively treated with antibiotics, although it is important for sexual partners to be treated as well to prevent re-infection. Preventive measures include practicing safe sex, getting regular STI screenings, and, if diagnosed, informing sexual partners so that they can get tested and treated as well (Geisler et al., 2022). Chlamydia is typically treated with antibiotics. The most prescribed antibiotics for chlamydia include azithromycin and doxycycline. These antibiotics are effective in treating the infection and are usually taken orally in a single dose or over the course of a week. It is important to complete the full course of antibiotics as prescribed by a healthcare provider, even if symptoms improve before the medication is finished (Geisler et al., 2022). Additionally, it is important to abstain from sexual activity during treatment and to inform sexual partners so that they can also be tested and treated if necessary. After completing treatment, it is advisable to undergo follow-up testing to ensure that the infection has been cleared (Geisler et al., 2022). Given our patient, his symptoms were burning urination and white discharge and admitted of unprotected sex last month.
Given the patient has a complex set of symptoms and conditions, it is important for him to receive appropriate treatment. Based on the information provided, it is recommended that macrolide antibiotics, such as azithromycin, are commonly used in the treatment of both pneumonia (PNA) and chlamydia due to their broad-spectrum activity and favorable pharmacokinetic properties (Porter et al., 2020). As macrolides have activity against a wide range of respiratory pathogens, including common bacteria associated with community-acquired pneumonia, such as Streptococcus pneumoniae, haemophiles influenzae, and atypical pathogens like mycoplasma pneumoniae and Chlamydophila pneumoniae (Porter et al., 2020). This broad coverage makes macrolides effective in treating pneumonia caused by these pathogens and are particularly effective against atypical pathogens, which are often implicated in atypical or walking pneumonia. These atypical pathogens include mycoplasma pneumoniae, Chlamydophila pneumoniae, and legionella pneumophila. Among others, macrolides, including azithromycin, are also effective in treating chlamydia infections (Romero et al., 2020). They are recommended as first-line therapy for uncomplicated urogenital chlamydia infections due to their high efficacy and convenient dosing regimens. Macrolides have good tissue penetration, including into respiratory tissues, which is important for treating respiratory infections like pneumonia and are available in oral dosage forms, which makes them convenient for outpatient treatment of both pneumonia and chlamydia, especially when compliance with treatment is a consideration (Romero et al., 2020).
It is important to note that the choice of antibiotic should be made based on factors such as local resistance patterns, individual patient factors (e.g., allergies, drug interactions, comorbidities), and specific guidelines and recommendations (Romero et al., 2020).
1. Recommended medications for this specific patient: (Drugs 2024)
a. Antibiotic for Pneumonia and Chlamydia: Azithromycin
– Drug Class: Macrolide Antibiotic
– Generic Name: Azithromycin
– Trade Name: Zithromax, Z-Pak
– Initial Starting Dose: 500 mg orally once daily for 3 days
b. Seasonal Allergies: Antihistamine and Decongestant Combination (Drugs 2024)
– Drug Class: Antihistamine and Decongestant
– Generic Name: Loratadine-Pseudoephedrine
– Trade Name: Claritin-D
– Initial Starting Dose: One tablet orally once daily
c. Sexually Transmitted Infection: Antibiotic for Chlamydia: (Drugs 2024)
– Drug Class: Antibiotic
– Generic Name: Azithromycin
– Trade Name: Zithromax, Z-Pak
– Initial Starting Dose: 1000 mg orally once as a single dose
2. Mechanism of action of the drugs listed: (Drugs 2024)
a. Azithromycin: It inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit of susceptible microorganisms, thus preventing the growth and reproduction of the bacteria.
b. Loratadine-Pseudoephedrine: Loratadine is an antihistamine that blocks the action of histamine, relieving allergy symptoms. Pseudoephedrine is a decongestant that works by narrowing the blood vessels in the nasal passages, reducing congestion.
3. Side effects of each drug: (Drugs 2024)
a. Azithromycin: Common side effects include diarrhea, nausea, abdominal pain, and vomiting. Less common but more severe side effects may include liver problems and allergic reactions.
b. Loratadine-Pseudoephedrine: Common side effects include dry mouth, headache, insomnia, and increased heart rate. Pseudoephedrine can also cause increased blood pressure.
4. Drug interactions between medications: (Drugs 2024)
a. Azithromycin and Loratadine-Pseudoephedrine: There are no known interactions between azithromycin and loratadine-pseudoephedrine. However, it is always important to inform the healthcare provider about all medications being taken to avoid potential interactions.
5. Other non-pharmacological interventions: (Drugs 2024)
a. For seasonal allergies: The patient should be advised to avoid allergens, such as pollen, and to use air purifiers or close windows during high pollen seasons. Nasal saline irrigation can also help clear nasal passages.
b. For Chlamydia: The patient should be counseled on safe sex practices and the importance of informing recent sexual partners about potential exposure.
Yes, I will be prescribing Z-pack to treat both conditions, PNA and Chlamydia, as the patient can be benefited from one antibiotic with two different conditions, and it prevents increased chances of multiple side effects. Pt can take, Z-pack x 1 dose of 1000 mg day one for chlamydia and will be taking the rest of the 3 days continue the recommended dose of 500 mg for PNA. It is important to note that the patient should follow up with a healthcare provider for a comprehensive evaluation and personalized treatment plan.
Reference
Azithromycin+ – search results. page 1 of about 5865 results. Drugs.com 2024 (n.d.). https://www.drugs.com/search.php?searchterm=Azithr…
Eshwara VK, Mukhopadhyay C, Rello J. Community-acquired bacterial pneumonia in adults: An update. Indian J Med Res. 2020 Apr;151(4):287-302.
Geisler WM, Hocking JS, Darville T, Batteiger BE, Brunham RC. Diagnosis and management of uncomplicated chlamydia trachomatis infections in adolescents and adults: Summary of evidence reviewed for the 2021 Centers for Disease Control and Prevention sexually transmitted infections treatment guidelines. Clin Infect Dis. 2022 Apr 13;74(Suppl_2): S112-S126.
Loratidine – search results. page 1 of about 10 results. Drugs.com. 2024 (n.d.-b). https://www.drugs.com/search.php?searchterm=lorati…
Porter JD, Watson J, Roberts LR, Gill SK, Groves H, Dhariwal J, Almond MH, Wong E, Walton RP, Jones LH, Tregoning J, Kilty I, Johnston SL, Edwards MR. Identification of novel macrolides with antibacterial, anti-inflammatory and type I and III IFN-augmenting activity in airway epithelium. J Antimicrob Chemother. 2020 Oct;71(10):2767-81
Romero L, Huerfano C, Grillo-Ardila CF. Macrolides for treatment of Haemophiles ducreyi infection in sexually active adults. Cochrane Database Syst Rev. 2020 Dec 11;12(12):CD012492.
