Figure 1
Figure 2
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Prepared by...
Virat Sirisanthana, M.D. * |
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* Department of Pediatrics,
Chiang Mai University
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Answer: Pneumococcal
pneumonia.
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| Continued : | ||
| Pleural tap
obtained 5 cc of exudative fluid ( numerour PMN, prot 4.3/6.1LDH 1209/328,
no organism seen). The hemoculture and pleural fluid culture grew : Streptococcal pneumoniae (reported as : resistance to penicillin by disk method). The patient was already started on ampicillin - > cefotaxime for 36 hours. The fever subsided 24 hours after initiation of antibiotic. |
| Question: Can the patient be treated with PGS? | ||
| Answer: Yes. | ||
| The
antibiotic was switched to PGS 100,000 U/kg/day and continued for total
of 10 days. Repeated CXR on day 6 of treatment is in figure 2.The course of hospitalization is shown in figure 3 |
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Figure 1
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Figure 2
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Figure 3
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Interesting
point: Although Streptococcal pneumoniae is not susceptible to
penicillin by disk
(1 microgram oxacillin) method, most of pneumococcal diseases (pnuemoniae, occult bacteremia, bacteremia) can still be treated with PGS. This is explained by the adequate level of penicillin to the sites of infection when given parenterally. "Meningitis" is the disease that adequate level of penicillin is difficult to achieve. In patient with meningitis, when DRSP is suspected to be the causative agent, the patient should be started on vancomycin + cefotaxime. |