From the Guidelines
For mild upper right lung pneumonia, adding doxycycline to Augmentin is reasonable since azithromycin cannot be used due to medication interactions. Doxycycline 100mg twice daily for 5-7 days would provide coverage for atypical pathogens that Augmentin alone may miss, as suggested by guidelines for managing community-acquired pneumonia 1. Regarding the calcified granuloma,
- a repeat CXR in 3 weeks is sufficient rather than another CT scan,
- calcified granulomas are typically benign findings representing healed infections (often from prior tuberculosis, histoplasmosis, or other infections) and don't require short-term follow-up imaging if they're stable from previous studies 1. The current focus should be on treating the pneumonia with appropriate antibiotics and monitoring the patient's dyspnea on exertion. If symptoms worsen despite antibiotics or don't improve within 48-72 hours, reassessment would be warranted. The 3-week follow-up CXR will help confirm resolution of the pneumonia while also documenting the stable nature of the granuloma. Given the patient's condition and the need for effective treatment, prioritizing the management of pneumonia is crucial, and the addition of doxycycline to Augmentin, along with monitoring and a follow-up CXR, aligns with the goal of improving morbidity, mortality, and quality of life outcomes.
From the Research
Treatment Options
- The patient has been started on Augmentin, and the question is whether to add doxy (doxycycline) to the treatment regimen. According to 2, doxycycline can be used in combination therapy for the treatment of community-acquired pneumonia, and its efficacy is comparable to macrolides.
- A study published in 3 found that doxycycline has a similar clinical cure rate to macrolides or fluoroquinolones in mild-to-moderate community-acquired pneumonia, making it a viable treatment option.
- However, it's essential to consider the potential disadvantages of combination therapy, including increased expense, risk of adverse effects, antagonism, and superinfection, as noted in 4.
Management of the Calcified Granuloma
- The patient has a 1cm calcified granuloma that was seen on Lung CT 2 weeks ago. The question is whether to repeat the lung CT or wait for the repeat CXR in 3 weeks.
- There is no direct evidence in the provided studies to guide the management of the calcified granuloma. However, it's worth noting that the presence of a calcified granuloma may not require immediate attention, and a repeat CXR in 3 weeks may be sufficient to monitor the patient's condition.
Considerations for Adding Doxycycline
- Before adding doxycycline to the treatment regimen, it's crucial to consider the patient's individual needs and potential interactions with other medications.
- As noted in 5, doxycycline has excellent activity against gram-positive and gram-negative aerobic and anaerobic pathogens, and its tissue penetration is excellent, making it a potentially effective treatment option for community-acquired pneumonia.