The use of antibiotics in the wards-Dharishini

No.	Antibiotics Details	Diagnosis	Antibiotics Prescribed	Discussion
1	17 y.o.Malay Boy, NKMI	Post Right Suboccipital Craniotomy for Right Cerebral Abscess	IV Ceftriaxone 2g Twice Daily	Ceftriaxone is a third generation cephalosporin.  it has broad-spectrum activity against Gram positive and Gram Negative bacteria
2	79 y.o Malay male u/l DM, HPT,COPD,  IHD, Gastritis, BPH	Acute Exacerbation of Chronic Obstructive Pulmonary disease secondary to CAP	IV Augmentin 1.2g TDS T. Azithromycin 500mg OD	Augmentin is usually used for B-Lactamase producing bacteria such as Strep pneu., H. influenza, Moraxella c. Azithromycin is used for CAP.
3	76 y.o Malay male U/L HPT, Dyslipidemia, COPD	Acute Exacerbation of Chronic Obstructive Pulmonary Disease secondary to CAP	T. Erythromycin 800mg BD IV Augmentin 1.2g TDS	Augmentin is usually used for B-Lactamase producing bacteria such as Strep pneu., H. influenza, Moraxella c. Erythromycin is  prescribed to treat acute bacterial infections
4	78 y.o. Malay male NKMI	CAP	T. Erythromycin 800mg BD IV Augmentin 1.2g TDS
5	52 y.o Malay Female U/L: DM and HPT	Sepsis secondary to Urinary tract Infection	IV Augmentin 1.2g TDS	Augmentin is used to treat B-lactamase producing bacteria such as in Urinary tract infections.
6	66 y.o Malay Female U/L: DM, ESRF, IHD, CVA	1.Acute Pulmonary Oedema secondary to Hypertensive Emergency 2. Hospital Acquired Pneumonia	IV Cefepime 1g BD	Cefepime is a fourth generation cephalosporin. It is used as a broad spectrum antibiotic targeting moderate to severe hospital acquired infections caused by multi-resistant bacteria such as pseudomonas aeruginosa.
7	54 y.o Malay Female U/L COPD, DM, HPT	AECOAD secondary to CAP	IV Augmentin 1.2g TDS T. Azithromycin 500mg OD
8	63 y.o Malay Female U/L: DM,HPT, Dyslipidemia	1.      Urosepsis secondary to urinary tract infection 2.      Acute coronary syndrome	T. Erythromycin 800mg BD IV Augmentin 1.2g TDS Changed to 1.IV Ceftriaxone 2g OD 2. T.Doxycycline 100mg BD	Patient’s antibiotic was changed because patient was not responding and her fever had not reduced. Doxycycline is a tetracycline. Susceptible organisms include Moraxella catarhalis, Brucella melitensis, Chlamydia pneumoniae, and Mycoplasma pneumoniae . Some H. influenza strains have acquired resistance.
9	48 y.o. Chinese female U/L Bronchial asthma, HPT	AEBA secondary to CAP	IV Augmentin 1.2g TDS T. Azithromycin 500mg OD
10	64 y.o Indian Male U/L COPD, HPT, DM	AECOAD secondary to CAP	IV Augmentin 1.2g TDS T. Azithromycin 500mg OD

Most of the patients above who were prescribed antibiotics were apropiate to the provisional diagnosis made and the presenting complaints of the patients. However in patient no. 8, I disagree with the prescription of Erythromycin in that patient as for sepsis, erythromycin is not suitable since it is a bacteriostatic antibiotic. Fortunately, it was changed to Ceftriaxone and doxycycline and patient recovered well. In this hospital, community acquired pneumonia the drug of choice is Augmentin and Erythromycin. Augmentin is prescribed because Augmentin contains B-lactam antibiotic with B-lactamase inhibitor. Hence it has a increased spectrum of action and is also efective against bacteria which produce B-lactamase. Erythromycin is a macrolide and is a bacteriostatic antibiotic. As such both drugs are prescribed together as one antibiotic is bacteriocidal and one is bacteriostatic. 

-Dharishini-