From the Guidelines
The new SOS antibiotic plan should be amoxicillin 500 mg three times a day for 14 days, as it is the recommended first-line treatment for Streptococcus pneumoniae and Haemophilus influenzae, and the isolated Beta Haemolytic streptococcus group C/G is sensitive to amoxicillin 1.
Considerations for Pseudomonas aeruginosa
- The Pseudomonas aeruginosa shows intermediate sensitivity to ciprofloxacin and piperacillin-tazobactam, but amoxicillin is not the preferred choice for Pseudomonas coverage.
- However, considering the patient's current stability and the absence of severe infection signs, amoxicillin can be a reasonable option for SOS use, with the understanding that it may not provide optimal coverage for Pseudomonas.
Previous SOS Antibiotic
- The previous SOS antibiotic, ceftriaxone, is not ideal based on the current culture results, as it would not adequately cover the Pseudomonas, which shows resistance to meropenem, suggesting possible resistance to other beta-lactams 1.
Monitoring and Adjustments
- The patient should be instructed to start the antibiotics if they notice increased yellow or green sputum production, increased cough, fever, or worsening shortness of breath.
- If the patient develops signs of more severe infection or fails to respond to amoxicillin, they should be reassessed for possible IV therapy with piperacillin-tazobactam or other suitable options, as recommended by the British Thoracic Society guideline for bronchiectasis in adults 1.
Key Points
- The patient's current stability and absence of severe infection signs support the use of amoxicillin as an SOS antibiotic.
- Close monitoring and prompt reassessment are crucial to ensure the patient receives appropriate treatment and to prevent potential complications.
- The British Thoracic Society guideline provides a framework for managing bronchiectasis and acute exacerbations, and its recommendations should be considered when developing an SOS antibiotic plan 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
New SOS Abx Plan
The patient's current sputum sample shows Beta Haemolytic streptococcus group C/G and Pseudomonas aeruginosa. Given the patient's previous SOS Abx was ceftriaxone, which is not mentioned on this report, a new plan should be considered.
- The patient is currently not on antibiotic treatment as there are no further instances of yellow sputum and the patient is medically stable.
- However, considering the sensitivity and resistance patterns of the isolated organisms, the following points should be taken into account:
- Beta Haemolytic streptococcus group C/G is sensitive to Teicoplanin and Amoxicillin, but resistant to Clindamycin and Erythromycin.
- Pseudomonas aeruginosa is intermediately sensitive to Ciprofloxacin and Pip-taz, but resistant to Meropenem.
Considerations for Pseudomonas aeruginosa Treatment
- According to 2, novel fluoroquinolones and new combinations of β-lactams/β-lactamase inhibitors have shown promising results against P. aeruginosa.
- The study 3 suggests that ceftazidime, carbapenems, or piperacillin-tazobactam can be used as single definitive therapy for P. aeruginosa bloodstream infection, with no significant difference in mortality, clinical, and microbiological outcomes or adverse events.
- However, the study 3 also notes that isolation of P. aeruginosa with new resistance to antipseudomonal drugs was significantly more frequent with carbapenems, suggesting the use of ceftazidime or piperacillin-tazobactam for treating susceptible infections.
Potential New SOS Abx Plan
- Based on the sensitivity patterns, a potential new SOS Abx plan could include Teicoplanin or Amoxicillin for Beta Haemolytic streptococcus group C/G.
- For Pseudomonas aeruginosa, considering the intermediate sensitivity to Ciprofloxacin and Pip-taz, and resistance to Meropenem, a potential option could be ceftazidime or piperacillin-tazobactam, as suggested by 3.
- However, it is essential to note that the patient is currently medically stable, and the decision to start antibiotic treatment should be based on clinical judgment and careful consideration of the patient's overall condition.