What should I do if I was discharged from the hospital with antibiotics for pneumonia that are not effective against my bacteria, as shown on my bacteria susceptibility report, and I left the hospital against medical advice (AMA) before the report was available?

Management of Pneumonia with Inappropriate Antibiotics After AMA Discharge

You should contact your healthcare provider immediately to switch to an appropriate antibiotic based on your susceptibility report to ensure effective treatment of your pneumonia.

Understanding the Situation

When a patient leaves the hospital against medical advice (AMA) before bacterial susceptibility results are available, and is subsequently found to be on ineffective antibiotics, this creates a potentially dangerous situation that requires prompt intervention. The Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) guidelines emphasize that antibiotic selection should be based on susceptibility testing results when available 1.

Immediate Actions Required

1. Contact your primary care provider (PCP) immediately

   • Do not wait for your condition to worsen
   • Inform them you have susceptibility results showing your current antibiotic is ineffective
   • If you cannot reach your PCP, consider urgent care or emergency department evaluation

2. Have your susceptibility report available

   • This report shows which antibiotics will work against your specific bacteria
   • Your PCP needs this information to select an appropriate antibiotic

3. Continue taking your current antibiotic until instructed otherwise

   • Even if ineffective, do not stop medication without medical advice
   • Abrupt discontinuation could potentially worsen your condition

What Your Provider Should Do

When you contact your provider, they should:

1. Review your susceptibility report to determine which antibiotics will be effective against your specific bacteria 1

2. Prescribe an appropriate antibiotic based on:

   • Susceptibility results
   • Your clinical condition
   • Your medical history and allergies
   • The type of pneumonia (community-acquired vs. hospital-acquired)

3. Determine if you need in-person evaluation based on:

   • Severity of your symptoms
   • Risk factors for deterioration
   • Need for additional testing

Warning Signs Requiring Emergency Care

While waiting to connect with your provider, seek immediate emergency care if you experience:

• Increasing shortness of breath
• High fever (>101°F or 38.3°C)
• Confusion or altered mental status
• Chest pain
• Coughing up blood
• Inability to take oral medications or fluids

Importance of Appropriate Antibiotic Therapy

Using an antibiotic that your bacteria is not susceptible to can lead to:

1. Treatment failure - The infection will not be cleared
2. Disease progression - Pneumonia can worsen and spread
3. Complications - Including respiratory failure, sepsis, or death
4. Antibiotic resistance - Taking ineffective antibiotics can promote resistance

The IDSA/ATS guidelines strongly recommend that antibiotic therapy for pneumonia should be based on susceptibility testing results to ensure optimal outcomes 1, 2. Treatment failure due to inappropriate antibiotic selection is associated with increased mortality and morbidity 1.

Follow-up Care

After starting appropriate antibiotics:

1. Schedule a follow-up appointment with your provider within 48-72 hours 1
2. Complete the full course of the newly prescribed antibiotic
3. Monitor for improvement - You should start feeling better within 2-3 days of starting effective antibiotics 1
4. Consider a follow-up chest X-ray if recommended by your provider

Prevention of Future Issues

To prevent similar situations in the future:

1. Avoid leaving the hospital AMA, especially when awaiting critical test results
2. Discuss concerns with your healthcare team before deciding to leave
3. Ensure you have a follow-up plan if you must leave before treatment is complete

Common Pitfalls to Avoid

1. Delaying contact with healthcare provider - This can lead to worsening infection
2. Self-medicating with leftover antibiotics or someone else's medication
3. Stopping antibiotics without medical advice
4. Assuming mild symptoms mean the infection is resolving - Pneumonia can rapidly worsen even with seemingly mild symptoms

Remember that pneumonia is a serious infection that requires appropriate antibiotic therapy based on susceptibility testing. Prompt action to obtain effective antibiotics is essential to prevent complications and ensure recovery.