From the FDA Drug Label
Patient Package Insert Albuterol Sulfate Inhalation Solution, 0.083%* 2. 5 mg*/3 mL The FDA drug label does not answer the question.
From the Research
The next step for a patient with pneumonia who has completed Augmentin treatment but still has persistent wheezing should be prompt medical reevaluation. The patient should see their healthcare provider for a thorough assessment, which may include chest imaging (X-ray or CT scan) to evaluate for unresolved pneumonia or complications, as suggested by the need for thorough assessment in patients with respiratory symptoms 1. The provider may consider adding a bronchodilator such as albuterol (2 puffs every 4-6 hours as needed) to address the wheezing, and possibly a short course of oral corticosteroids like prednisone (typically 40mg daily for 5 days) if inflammation is significant. If bacterial resistance is suspected, a different antibiotic such as a respiratory fluoroquinolone (levofloxacin 750mg daily for 5-7 days) or doxycycline (100mg twice daily for 7-10 days) might be prescribed. Persistent wheezing after antibiotic treatment could indicate several possibilities: the pneumonia hasn't fully resolved, there's an underlying condition like asthma or COPD, the infection was viral rather than bacterial, or there could be a complication such as pleural effusion, as seen in cases of amiodarone-induced pulmonary toxicity 2. Without proper follow-up, these conditions could worsen and lead to more serious respiratory compromise. It's also important to consider the patient's history and physical examination to evaluate the likelihood of asthma versus other underlying causes of wheezing, such as cystic fibrosis, aspiration syndromes, congenital anomalies, or environmental factors 3. Bronchoprovocation testing may be useful in defining the cause of wheezing when reversible airflow obstruction has not been documented 4. However, the most recent and highest quality study 2 suggests that a thorough assessment and consideration of the patient's history and physical examination are crucial in determining the next steps in management.
Some key points to consider in the management of this patient include:
- The need for prompt medical reevaluation to assess for unresolved pneumonia or complications
- The potential use of bronchodilators and oral corticosteroids to address wheezing and inflammation
- The consideration of alternative antibiotics if bacterial resistance is suspected
- The importance of evaluating the patient's history and physical examination to determine the underlying cause of wheezing
- The potential use of bronchoprovocation testing to define the cause of wheezing.