What treatment is recommended for a 65-year-old female patient with pneumonia (PNA) who has a nonproductive cough, having failed outpatient treatment?

From the Guidelines

I recommend prescribing dextromethorphan 30mg every 6-8 hours as needed for this patient's nonproductive cough. This medication is appropriate for a 65-year-old female hospitalized with pneumonia who has failed outpatient treatment and is specifically requesting cough suppression. Dextromethorphan works by acting on the cough center in the medulla oblongata to suppress the cough reflex. Since her cough is nonproductive, suppressing it is reasonable to improve comfort and potentially sleep quality. The provided evidence 1 focuses on the management of hospital-acquired pneumonia, including recommended initial empiric antibiotic therapy, but does not directly address cough suppression. However, it is crucial to note that the primary treatment for pneumonia should be antibiotics, as outlined in the guidelines. Alternative options could include benzonatate 100-200mg three times daily if dextromethorphan is contraindicated or not tolerated. It's essential to ensure the patient stays well-hydrated and maintains good pulmonary hygiene despite cough suppression. The medication should be used for symptom management while the underlying pneumonia is being treated with appropriate antibiotics, as suggested by the guidelines 1. Reassess the need for cough suppression daily as her condition improves, and discontinue when no longer necessary. Key considerations in managing this patient's cough include:

• Ensuring the patient's pneumonia is adequately treated with antibiotics
• Monitoring for potential side effects of cough suppressants
• Encouraging good pulmonary hygiene and hydration
• Regularly reassessing the need for cough suppression as the patient's condition evolves.

From the Research

Patient Assessment

• The patient, LABRADA PARRA MAGALY PARRA, is a 65-year-old female admitted for Pneumonia (PNA) who has failed outpatient treatment and is now asking for cough medicine due to a nonproductive cough.
• According to the study 2, pneumonia is a common acute respiratory infection that affects the alveoli and distal airways, and it is a major health problem associated with high morbidity and short-term and long-term mortality in all age groups worldwide.

Cough Management

• The study 3 suggests that chronic cough in adults can be caused by many etiologies, but four conditions account for most cases: upper airway cough syndrome, gastroesophageal reflux disease/laryngopharyngeal reflux disease, asthma, and nonasthmatic eosinophilic bronchitis.
• For nonproductive cough, the study 4 found that non-pharmacological therapies such as education, cough suppression, breathing techniques, mindfulness, and continuous positive airway pressure can improve cough-specific health-related quality of life, cough frequency, and voice outcomes.

Pneumonia Treatment

• The study 2 emphasizes the importance of identifying the causative pathogens of pneumonia, as delayed and inadequate antimicrobial therapy can lead to poor outcomes.
• The study 5 found that improving hydration reduces the risk of medium-term mortality in all types of pneumonia, and supporting hydration and reversing dehydration has the potential to have rapid positive impacts on pneumonia outcomes.
• However, the study 6 highlights the issue of inappropriate use of antimicrobial therapy in patients with congestive heart failure or fluid congestion misdiagnosed as pneumonia, emphasizing the need for appropriate interpretation of radiographic evidence, laboratory data, and critical clinical assessment.

Considerations for Patient Care

• Given the patient's failed outpatient treatment and current symptoms, it is essential to reassess her condition and consider the potential causes of her nonproductive cough, as well as the most effective treatment options.
• The patient's hydration status should be closely monitored, and efforts should be made to improve hydration to reduce the risk of medium-term mortality.
• A thorough evaluation of the patient's condition, including radiographic evidence, laboratory data, and clinical assessment, is necessary to determine the best course of treatment and avoid inappropriate use of antimicrobial therapy.