A 17-year-old female presented with a 2 week history of cough, chest pain, and fever and was diagnosed with left lower lobe pneumonia. She was treated with intravenous antibiotics including cefotaxime, azithromycin, and piperacillin-tazobactam. Her symptoms improved and she was discharged after 9 days without complications.

1. REG NO: 132820210

3. “Left Lower Lobe Pneumonia”

4. 1. PATIENT DETAILS:
- NAME : Ms. Y
- Age : 17 yrs
- Sex : F
- I.P No: 197121
- Department : GM
- Weight: 58 kg
- Height: 165 cm
- BMI: 21.303
- DOA : 19/10/2016
- DOD: 27/10/2016

5. 2. REASON FOR ADMISSION:
Patient had c/o:
i. Cough for 2 weeks
ii. Pleuritic chest pain for 2 weeks
iii. Headache(occurred 2 weeks back, and lasted for 5 hours)
3. PAST MEDICAL HISTORY: Not significant
4. FAMILY HISTORY : Not significant
5. SOCIAL HABITS:
- Non-smoker
- Non- alcoholic

6. 6. KNOWN ALLERGIES : Nil
7. FOOD HABITS: Non-vegetarian

7. 1. VITALS CHART :
DATE 19/10 20/10 21/10 22/10 23/10 24/10 25/10 26/10 27/10
TEMP. 100 99 N 99 N N N N N
B.P 120/70 130/80 110/70 130/90 120/70 120/70 130/90 120/90 110/90
PULS
E
88 90 106 80 84 88 86 90 92
RBS 115
RR 22 20 20 20 24 22 20 24 24

8. 2. BLOOD COUNTS:
i. Hb : 12 g/dl
ii. ESR: 15 mm/hr
iii. Platelet count: 2.47 lakhs
iv. WBC : 10,140 cells/cumm
v. DLC:
a. Neutrophils: 80.5%
b. Lymphocytes: 13.5%
c. Monocytes : 5.2 %
d. Eosinophils: 0.5%
e. Basophils: 0.2%

9. 3. LFTs:
i. Total bilirubin: 0.30 mg%
ii. Direct bilirubin: 0.01 mg%
iii. Albumin: 3.72 mg/dl
iv. ALP: 48 IU/L
v. SGPT: 10 IU/L
vi. SGOT: 18 IU/L
vii. Total protein: 6.74 mg%
viii. Globulin: 3.02 mg%

10. 4. RFTs:
i. Urea: 17.03 mg%
ii. Uric acid: 4.28 mg/dl
iii. SCr: 1.03 mg%
5. ELECTROLYTES: (In mEq/L)
i. Sodium: 135
ii. Potassium : 4.0
iii. Calcium: 9.6
6. OTHERS:
- Coarse creps in infrascapular & interscapular area
- CNS: WNL
- GIT: Soft, non-tender. . .

11. 1. DIAGNOSIS: “Left lower lobe pneumonia”
2. ASSESSMENT, IF THERAPY INDICATED:
i. To alleviate signs and symptoms
ii. To avoid complications
iii. To reduce ADRs , associated with therapy
iv. To improve HRQoL. . .

12. 3. ASSESSMENT OF CURRENT THERAPY:
Drugs given to the patient, involve:
i. INJ. MONOCEF(CEFTRIAXONE) ; 1g i.v; Q12H (D1 & D4):
- 3rd generation cephalosporin, bactericidal in nature, by working against cell wall
synthesis
- Covers major spectrums of GRAM NEGATIVE ORGANISMS
ii. T. ZITROBACT(AZITHROMYCIN), 500 mg P/O, OD, (D1-D4):
- INTIAL DRUG OF CHOICE, as it covers MOST OF PNEUMONIA
ETIOLOGICAL AGENTS, INCLUDING MYCOPLASMA SPECIES
- Has LESSER ADRs, compared to other drugs used under this disease

13. iii. T.PAN (PANTOPRAZOLE) ; 40 mg, P/O, OD, (D1-D9):
- Proton-pump inhibitor
- Has been used to act on GI parietal cells to prevent damages to GI epithelium
due to excess acid production, as a tantamount of antibiotics used in the patient.
iv. T.DOLO (ACETAMINOPHEN); 650 mg; P/O; (D1-D5):
- Helps to reduce fever, and also to alleviate pain(justifiable by the patient having
slightly raised temperature in initial days of admission, along with chest pain
and headache).
v. INJ. TAZOMAC (PIPERACILLIN+ TAZOBACTAM) , 4.5 g , i.v, Q8H (D4-D9):
- Effective, since it is ANTI-PSEUDOMONAL , coupled with BETA-LACTAMASE
INHIBITOR

14. vi. CAP. DIPEP(PEPSIN + CELLULASE + FUNGAL DIASTASE+ PAPAIN) , 10
mg, 1 capsule per day, (D5-D9):
- Has many implications, but here its used to improve digestion, and enhance
affinity towards having good meals.
vii. T. MOXIF( MOXIFLOXACIN) , 400 mg P/O, BD(D3-D9):
- Fluoroquinolone antibiotic(4th generation) bactericidal, that disrupts bacterial
DNA replication

15. DRUG
NAME
DOSE 19/10 20/10 21/10 22/10 23/10 24/10 25/10 26/10 27/10
Inj.
Monocef
1 g i.v
Q12H
Y Y
T.
Zitrobact
500 mg
P/O ,
OD
Y Y Y Y
T. Pan 40 mg
P/O
Y Y Y Y Y Y Y Y Y
T. Dolo 650 mg
P/O,
TID
Y Y Y Y Y
Inj.Tazo
mac
4.5 g i.v
Q8H
Y Y Y Y Y Y
C.
Dipep
1 cap
OD
Y Y Y Y Y
T. Moxif 400 mg,
P/O ,
Y Y Y Y Y Y Y

16. PROGRESS CHART:
1. 19/10/16:
- Patient was febrile
- Chest showed coarse creps on left interscapular & infrascapular areas
2. 20/10/16:
- Temperature slightly reduced
- Patient had c/o consistent cough
3. 21/10/16:
- No fresh complaints
- Febrile
4. 22/10/16:
- No fresh complaints

17. 5. 23/10/16:
- No fresh complaints
6. 24/10/16:
- Febrile
- No fresh complaints
- C/0 indigestion
7. 25/10/16:
- No fresh complaints
8. 26/10/16:
- No fresh complaints
9. 27/10/16:
- No fresh complaints, the patient felt better, and was discharged appropriately. . .

18. DISCHARGE SUMMARY:
“ A 17 year old girl, with no other co-morbidities, presented with COUGH,
PLEURITIC CHEST PAIN(for 2 weeks), and HIGH GRADE FEVER (for 2 days).
On observation: Conscious, oriented, patient was febrile, creps(+ve), X-ray chest
done.
Patient was treated with i.v antibiotics . Patient was found to improve
symptomatically. CT-thorax was planned. Patient was found to be better, and was
discharged appropriately.”

19. DISEASE-RELATED COUNSELLING:
a. Focus on the following remedies:
1. Cayenne pepper
2. Turmeric
3. Black pepper
4. Garlic
5. Ginger
6. Sesame seeds
7. Fenugreek seeds. . .

21. POINTS TO BE MONITORED:
1. PIPERACILLIN + TAZOBACTAM :
- Monitor for LFTs, (AST & ALT levels)
- Perform urinalysis and BUN and creatinine levels measurements during therapy
2. MOXIFLOXACIN :
- Use, with CAUTION, for PROLONGED THERAPY, since they are associated
with SUPERINFECTIONS with prolonged/ repeated therapy
- May also cause TENDONITIS/ MUSCLE RUPTURES. . .

22. THANK YOU !!!!