Paracetamol (Acetaminophen) Should Be Stopped
In a patient with pneumonia who is now afebrile and clinically improved after 24 hours, paracetamol is the most appropriate medication to discontinue. 1
Rationale for Stopping Paracetamol
- Paracetamol's primary indication in pneumonia is symptomatic relief of fever and pain, not treatment of the underlying infection 2
- Once the patient is afebrile, the antipyretic function of paracetamol is no longer needed 1
- The patient has achieved defervescence, eliminating the primary indication for continued paracetamol therapy 1
Why Antibiotics Must Continue
Both ceftriaxone and azithromycin must be continued despite clinical improvement at 24 hours. 2, 1
Minimum Duration Requirements
- IDSA/ATS guidelines mandate a minimum of 5 days of antibiotic therapy for community-acquired pneumonia 2
- Patients must be afebrile for 48-72 hours (not just 24 hours) before antibiotic discontinuation can be considered 2, 1
- Patients must have no more than 1 CAP-associated sign of clinical instability before stopping antibiotics 2
Combination Therapy Benefits
- The combination of ceftriaxone plus azithromycin is the recommended regimen for hospitalized CAP patients per IDSA/ATS guidelines 2, 1
- This combination provides essential coverage against Streptococcus pneumoniae (including resistant strains) and atypical pathogens (Mycoplasma, Chlamydophila, Legionella) 2, 1
- Combination therapy has demonstrated synergistic effects that may improve outcomes in pneumococcal bacteremia 1
- Stopping either antibiotic prematurely at 24 hours would violate evidence-based guidelines and risk treatment failure 2, 1
Why Tramadol Should Continue
- Tramadol may still be needed for pleuritic chest pain or other pneumonia-associated discomfort that can persist even after defervescence 1
- Pleuritic pain should be relieved using simple analgesia 2
- Clinical improvement at 24 hours does not guarantee resolution of all pain symptoms requiring analgesic management 2, 1
Critical Timing Pitfall
A common error is stopping antibiotics too early based on rapid clinical improvement. The 24-hour mark is far too early to discontinue antimicrobial therapy, even with complete defervescence. The minimum 5-day duration and 48-72 hour afebrile requirement exist to prevent relapse, ensure adequate pathogen eradication, and minimize resistance development 2, 1.
Answer: A - Paracetamol