Therapeutic Response of Community Acquired Pneumonia in Geriatrics: A Case Series from Intensive Care Unit

Abstract

Community acquired pneumonia (CAP) is a common major growing challenge to elderly populations. Several aging factors, including comorbidities, nutritional status and digestive dysfunctions have been associated with increasing CAP among older persons. Furthermore, Streptococcus pneumoniae remains the most predominant pathogen in geriatrics, although multiple drug resistance (MDR) species regularly occur, particularly in severe pneumonia. Broad-spectrum antibiotics or a combination of β-lactam and fluorokuinolones, or β-lactams and macrolides serve as a promising therapy mainly in critical CAP patients. This study describes two geriatric CAP cases representing two separate treatments with widely varied results. The combination of cefoperazone sulbactam-azithromycin did not generate suitable clinical response until 7 days. As a consequence, the macrolides were replaced with amikacin and continued for 3 days. Meanwhile, the cefoperazone sulbactam-levofloxacin samples significantly improved the clinical conditions under 9 days. The selection of antibiotics with sufficient lung penetration is important in providing the effective therapy. Conversely, azithromycin resistance potentially instigates ineffectiveness, but is also recommended due to its pleiotropic effects. The benefit of this case study shows that CAP treatment among older population requires a blend of antibiotics with either a fluorokuinolone or an aminoglycoside. In both instances, azitromisin is believed to demonstrate high resistance, therefore, it is incapable in functioning as a second antibiotic component.

Evaluasi Penggunaan Antibiotik dengan Metode ATC/DDD dan DU90% pada Pasien Pneumonia di RSD X Tahun 2022

“…Levofloksasin aktif terhadap bakteri gram negatif seperti Haemophillus influenzae dan bakteri gram positif seperti Streptococcus pneumonia, serta bakteri atipikal seperti Legionella sp, Mycoplasma pneumoniae, dan Chlamydia pneumoniae. Selain itu, levofoksasin merupakan antibiotik concentration dependent, hal ini berarti meningkatnya konsentrasi levofloksasin akan meningkatkan aktivitas bakterisidalnya (Widyati, et al, 2021)…”