From the Guidelines
The initial investigation for this 41-year-old woman should include bilirubin, albumin, alanine aminotransferase (ALT), alkaline phosphatase (ALP), and γ-glutamyltransferase (GGT), together with a full blood count if not already performed within the previous 12 months, as recommended by the guidelines on the management of abnormal liver blood tests 1. To properly assess her health status, a complete set of laboratory results including these markers would be needed. Without this information, it's impossible to provide specific recommendations.
- The extent of liver blood test abnormality is not necessarily a guide to clinical significance, which is determined by the specific analyte that is abnormal and the clinical context 1.
- Abnormal liver blood test results should only be interpreted after review of the previous results, past medical history, and current medical condition 1.
- Patients with abnormal liver blood tests should be considered for investigation with a liver aetiology screen, irrespective of the level and duration of abnormality, which includes abdominal ultrasound scan, hepatitis B surface antigen, hepatitis C antibody, and other tests as recommended 1.
- The guidelines emphasize the importance of considering the clinical context and past medical history when interpreting liver blood test results, rather than relying solely on the extent of abnormality 1.
- It is crucial to consult with a healthcare provider who can review the complete results in the context of the patient's medical history and current symptoms to make appropriate recommendations for follow-up testing, lifestyle modifications, or medical interventions.
From the Research
Patient's Lab Results and Potential Treatment Options
The patient's lab results are not provided, but based on the studies, we can discuss potential treatment options for various infections.
- The studies compare the efficacy of cefepime with other antibiotics, such as ceftriaxone, amikacin, and carbapenems, in treating different types of infections, including febrile neutropenia, bloodstream infections, and community-acquired infections 2, 3, 4, 5, 6.
- Cefepime is shown to be a safe and effective treatment option for patients with acute leukemia and febrile neutropenia, as well as for those with AmpC beta-lactamase-producing Enterobacterales bloodstream infections 2, 3.
- The studies also suggest that cefepime can be used as an empiric treatment for hospitalized patients with moderate to severe community-acquired infections, including urinary tract infections, intra-abdominal infections, and sepsis 4.
- However, one study found that empiric cefepime was associated with a delay in achieving clinical stability compared to meropenem in treating bloodstream infections caused by ceftriaxone-resistant Enterobacterales 6.
Potential Treatment Options for Different Infections
- For febrile neutropenia, cefepime or ceftriaxone plus amikacin can be used as empirical treatment 2.
- For AmpC beta-lactamase-producing Enterobacterales bloodstream infections, cefepime or carbapenems can be used 3.
- For community-acquired infections, cefepime or broad-spectrum combination therapy can be used 4.
- For bloodstream infections caused by ceftriaxone-resistant Enterobacterales, meropenem may be a better option than cefepime 6.
Considerations for Treatment
- The choice of antibiotic should be based on the severity of the infection, the patient's underlying health conditions, and the susceptibility of the infecting organism to the antibiotic 2, 3, 4, 5, 6.
- The potential for adverse events, such as renal impairment and neurologic adverse events, should also be considered when choosing an antibiotic 3, 6.