ANTIMICROBIAL CASE STUDY LATEST UPDATE

ANTIMICROBIAL CASE STUDY LATEST UPDATE 5334 CASE SUMMARY TABLE • Large swollen tonsils with white exudates and noted petechiae (Centers for Disease Control and Prevention [CDC], 2018) • Fever and enlarged cervical lymph nodes (CDC, 2018). 1. Amoxicillin (Halloran, 2013) 2. Azithromycin (Halloran, 2013) 3. Cephalexin (Halloran, 2013) 1. Amoxicillin - Category: Anti-infective; Subcategory: Aminopenicillin (Vallerand et. al., 2013, p. 144) 2. Azithromycin - Category: Anti-infective; Subcategory: macrolide (Vallerand, Sanoski, & Deglin, 2013, p. 1003) 3. Cephalexin - Category: Anti-infective; Subcategory: 1st generation cephalosporins (Vallerand et. al., 2013, p. 144) • Amoxicillin Patient presents with signs and symptoms which are indicative of Group A beta- hemolytic streptococcus (GABHS) pharyngitis including sore throat, fever, malaise, stomach and headache, enlarged cervical lymph nodes, erythematous tonsils with white exudates and soft palate petechiae, and a positive rapid antigen detection test (RADT) (CDC, 2018). A 10-day course of penicillin V is the optimal treatment for GABHS pharyngitis. However, amoxicillin is considered the first choice in antibiotic therapy for children over penicillin V due to its cost effectiveness, ease in administration, and low risk for harmfulness (Halloran, 2013). Additionally, amoxicillin is more palatable for children, increasing the likelihood for compliance with the treatment (Halloran, 2013). Palatability of a medication can be a significant barrier to compliance in children, choosing an effective medication with a tolerable taste for most is key. Another reason for using amoxicillin is its bioavailability and potential to have less diarrheal side effects (Burchum & Rosenthal, 2016, p. 1023). Contraindications for the use of amoxicillin are any hypersensitivity or allergy to penicillins or betalactams. This medication should not be administered to anyone with infectious mononucleosis, acute lymphocytic leukemia, or cytomegalovirus infection. Caution should be used when administering to anyone with severe renal dysfunction (Vallerand, Sanoski, & Deglin, 2013, p. 144). Side effects include diarrhea, nausea, vomiting, potential for increased liver enzymes, rash, urticaria, headache, and superinfection (Vallerand et. al., 2013, p. 144). Patients and families should be instructed to take this medication exactly as ordered and to complete the entire course of treatment, even if they begin to feel better (Vallerand et. al., 2013, p. 145). It is imperative parents of pediatric patients understand the importance of measuring doses accurately and using measuring devices supplied by the pharmacy as opposed to household utensils (Vallerand et. al., 2013, p. 145). Amoxicillin suspension needs to be shaken well prior to administration and given with food to avoid stomach upset. The suspension should also be refrigerated and not left on a counter at room temperature (Vallerand et. al., 2013, p. 144). Notify the healthcare provider of the development of diarrhea, abdominal cramping, fever, or bloody stools (Vallerand et. al., 2013, p. 145). DEA # BN NPI # 5 License # Sally Chambless 8784 Maverick Circle, Canton, TX 75103 Phone: (903) 567-1234 Fax: (903) 567-1235 Name: David Jacobs DOB: 04/15/2013 Address: 121 Blueberry Fields Date: 05/21/2018 M/F Canton, TX, 75103 Wt: 21kg Phone: (903) 567- 2211 Allergies: NKDA Rx Amoxicillin How Supplied: Amoxicillin 250mg/5ml oral suspension Route: Oral Duration of treatment: 10 days Administration: Administer 10 ml of Amoxicillin by mouth twice a day for 10 days. Distribute: 200ml Amoxicillin oral suspension Refills 1 2 3 4 5 Void after 11/21/2018 Substitution Permitted Yes Dispense as written No Signature Supplementary Documentation • Population and Pathophysiology Gram A beta-hemolytic streptococcus (GABHS) is the primary bacterial cause of all acute pharyngitis infections in children and adults commonly appearing in those between the ages of 5 and 15 years old (Wells, Schwinghammer, DiPiro, & DiPiro, 2017, p. 432). Group A strep pharyngitis can occur in people of all ages, but it is rare in children under the age of 3 and those in close contact with someone infected with the group A strep pharyngitis are at highest risk of contracting the infection themselves (Centers for Disease Control and Prevention [CDC], 2016). Crowded spaces as those found in schools, daycares, and military barracks increase the risk of spreading contractible diseases (CDC, 2016). GABHS is typically spread through direct contact via saliva or nasal secretion exchange from an infected person. The incubation period of GABHS is usually 2 to 5 days after contact with infected persons (CDC, 2016). • Signs and Symptoms The signs and symptoms of GABHS pharyngitis are sore throat, pain on swallowing, fever, headache, abdominal pain (particularly in children), inflammation of the tonsils with or without patchy exudates, petechiae of the soft palate, and distinctly enlarged cervical lymph nodes which are painful to the touch (Wells et al., 2017, p. 432). Onset of symptoms is usually sudden. • Goals of Treatment The primary goal of treatment is resolution of infection and the accompanying signs and symptoms of said infection. Subsequent, goals are, 1) to prevent disease transmission to close contacts (Wells et al., 2017, p. 432), 2) prevent the complications of untreated GABHS including acute rheumatic fever, peritonsillar abscess, mastoiditis, and cervical lymphadenitis, (CDC, 2016), and 3) avoiding the over prescribing of antibiotics by confirming the presence of GABHS with a positive RADT (CDC, 2016). • Amoxicillin o Class: Anti-infective; Aminopenicillin (Vallerand et. al., 2013, p. 144). ▪ Indications: Used for the treatment of skin infections, otitis media, sinusitis, respiratory infections, genitourinary infections, and gastrointestinal infections. Also used in the management of ulcer disease caused by Helicobacter (Vallerand et. al., 2013, p. 144). Actively effective against the following bacteria: Streptococci, Pneumococci, Enterococci, Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Neisseria meningitidis, N. gonorrhoeae, Shigella, Chlamydia trachomatis, Salmonella, Borrelia burgdorferi, and H. pylori (Vallerand et. al., 2013, p. 144). ▪ Mechanism of action: Amoxicillin acts by binding to the bacterial cell wall thus inhibiting cell synthesis. The lack of synthesis and resulting cell wall results in death by lysis of the bacteria (Vallerand et. al., 2013, p. 144). ▪ Pharmacodynamics: Amoxicillin is well absorbed from the duodenum and moderately resistant to acid inactivation, it is metabolized in the liver, diffuses into most tissues and fluids, and eliminated by the kidneys through urine. This medication penetrates the cerebral spinal fluid and crosses the placenta (Vallerand et. al., 2013, p. 144). ▪ Pharmacokinetics: The half-life of amoxicillin is approximately one hour with a duration of six to eight hours in normal renal function (Vallerand et. al., 2013, p. 144). Food has no effect on the absorption of amoxicillin (Vallerand et. al., 2013, p. 144) o Generic Name: Amoxicillin ▪ Dosing: The oral dose for children is 25-50mg/kg with doses divided over 12 hours with a maximum dosage of 500 mg per dose (Vallerand et. al., 2013, p. 144). The following formula was used in this case study to calculate dosing: 21kg * 50mg/kg = 1050 kg/day 1050kg/2 = 525mg/dose Amoxicillin 250mg/5 ml= 1000mg/x= 20ml per day* ½= 10 ml per dose ▪ Indications: Indicated for the treatment of gram-positive and gram-negative infections of the respiratory tract, skin, urinary tract, and gastrointestinal (Vallerand et. al., 2013, p. 144). ▪ Instructions: Patients and families should be instructed to take this medication exactly as ordered and to complete the entire course of treatment, even if they begin to feel better (Vallerand et. al., 2013, p. 145). It is imperative parents of pediatric patients understand the importance of measuring doses accurately and using measuring devices supplied by the pharmacy as opposed to household utensils (Vallerand et. al., 2013, p. 145). Amoxicillin suspension needs to be shaken well prior to administration and given with food to avoid stomach upset. The suspension should also be refrigerated and not left on a counter at room temperature (Vallerand et. al., 2013, p. 144). Notify the healthcare provider of the development of diarrhea, abdominal cramping, fever, or bloody stools (Vallerand et. al., 2013, p. 145). ▪ Side Effects: Side effects include diarrhea, nausea, vomiting, potential for increased liver enzymes, rash, urticaria, headache, and superinfection (Vallerand et. al., 2013, p. 144). ▪ Outcomes: The goal of treatment is resolution of infection and the accompanying signs and symptoms of said infection (Vallerand et. al., 2013, p. 144). References Burchum, J. R. & Rosenthal, L. D. (2016). Lehne’s Pharmacology for Nursing Care. St. Louis, MO: Elsevier Sanders