help needed critical care patient

[scottisheskimo]

Hi,

I am doing a pharmaceutical care plan for a patient in HDU suffering with Aspiration Pneumonia, Type 2 respiratory failure and acute renal failure due to sepsis. Respiratory rate 12, WCC 19.3 x109L, confused, hypoxic, elevated urea, creatinine 503microLitre. bp 105/56 mmHg
The patient is 63 male weighs 80kg.

Past medical Hx
osteoporosis
arthiritis

Current Rx
IV fluids,
O2
Tazocin 4.5g IV tds
Gentamicin IV 560mg


I would appreciate any help and advice you could give me.

[Band6]

Pharmaceutical issues:

1. Gentamicin levels - trough levels should be <1. Will need dose reduction in renal failure (nephrotoxic). As pt is in renal failure secondary to sepsis, hopefully renal function will come back - dose needs to be monitored against renal function.

2. Tazocin. Renally cleared, may need dose reduction. In practice, penicillins are not aggressively reduced in renal failure secondary to sepsis - depends on the hospital.

3. Aspiration pneumonia - should they be on metronidazole?

4. Can't remember what type 2 resp failure is - is the O2 Rx appropriate?

5. Needs plenty of fluids

Hope this helps,

Band6

[ramroum]

If you look at the SPC for both meds in renal impairment: Gent. should be reduced to 80mg OD, Tazocin to 4.5g BD in this patient as his crcl is about 15. No mention for allergies!
You can look at the "renal hand book" instead for doses.
When his renal function start to improve doses might be increased.
Every hospital has guidelines on the choice of antibiotics. I think our hospital uses only tazocin in this case.
What about CURB-65? confusion, urea, low blood pressure, age over 65. I am not sure how this is used!! I just realized that he is less than 65y.

[Band6]

CURB-65 is a grading tool for community acquired pneumonia. Aspiration pneumonia tends to involve odder bacteria, including anaerobes.

[bobbin]

Aspiration pneumonia - should they be on metronidazole

Could use metronidazole but Tazocin covers anaerobes.

Bobbin