Time Out! A Close Look at Antibiotic Use in Post-acute and Long-term Care

Neil Gaffin, MD


October 02, 2018

Diagnosing Pneumonia

The appropriate recommendation was to stop the levofloxacin, and the antibiotic was discontinued. Pneumonia is a clinical diagnosis that relies on a combination of elements from the history, physical exam, and supporting lab and radiologic findings. This patient's clinical picture was inconsistent with a diagnosis of pneumonia, and it was thought unlikely that the radiographic abnormality was related to a bacterial infection. She remained clinically stable until 4 days later, when she developed a fever and exam finding suggestive of congestive heart failure. She was transferred to the hospital and found to have C difficile colitis.

A Man With Leukocytosis

A 96-year-old man with several medical problems, including dementia and hairy cell leukemia (specific details unknown), had a rising WBC count over 10 days. His history was limited, but his nurse observed no changes in his clinical status, and he was afebrile. It was not known what prompted the initial complete blood cell count, but the abnormal WBC count was followed with serial WBC counts. When the WBC reached 18,000 cells/µL, urinalysis and urine culture were ordered. The former had 33 WBCs and a negative nitrite; the latter yielded > 100,000 colony-forming units of Escherichia coli, sensitive to all antibiotics tested. A 5-day course of double-strength trimethoprim-sulfamethoxazole was ordered.

Upon review of this case, you note that previous differentials revealed 70%-80% lymphocytes.


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