The Lean Antibiotic Mantra

Sometimes Nothing Is Better Than Something

Neil Gaffin, MD; Brad Spellberg, MD


April 09, 2018

As discussed already, procalcitonin is well validated as a biomarker to support cessation of antibiotic therapy in patients with respiratory tract infections. One of the major pitfalls in the diagnosis and management of pneumonia is the erroneous belief that chest radiographic or CT patterns have enough specificity to determine the type of pathogen responsible for a given pneumonia; both viruses and bacteria can cause similar radiographic patterns.[14,15]

Radiology reports alone cannot make an accurate pneumonia diagnosis and should not be the sole determinant of antibiotic therapy.[16,17] This patient received only 2 days of antibiotic therapy and was then discharged home without sequelae.

An Elderly Woman With Hematuria

A frail 95-year-old woman came to the ED from home with a 2-day history of hematuria, suprapubic discomfort, and difficulty voiding. She had been taking naproxen daily for leg pain after a recent fall. She did not have dysuria, fever, or chills. In the ED, she was afebrile. Bladder catheterization was significant for 450 mL of bloody urine. The WBC count was 7900 cells/µL. The BUN and creatinine levels were 39 md/dL and 2.1 mg/dL, respectively. Urinalysis revealed packed WBCs, red blood cells, and negative nitrate. CT revealed a "diffusely thick-walled urinary bladder."

The patient was believed to have hemorrhagic cystitis after a urology consultation, and she was started on ceftriaxone and intravenous fluids. The following day, she was pain-free and voiding without difficulty, and her urine was clearing. Urine culture revealed mixed organisms consistent with contamination.


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