Respiratory tract infection
A 24-years-old woman comes to a clinic with complaints of dry cough, headache, fever, and malaise, which have lasted 3 to 4 days. She appears to have some respiratory difficulty, and chest examination reveals rales but no other obvious signs of pulmonary involvement. However, extensive patchy infiltrates are seen on chest x-ray film. Gram stain of expectorated sputum fails to reveal any bacterial pathogens. The patient informs the attending physician that her husband is not sick but that a colleague at work has symptoms similar to those she is experiencing. The patient has no history of serious medical problems. The patient is taking loratadine for allergies, multivitamins, and supplementary iron tablets. She is an avid consumer of coffee and caffeinated beverages.
Questions:
1. What would be your initial diagnosis based on data provided?
2. What are the typical pathogens causing the initial diagnosis?
3. Regarding the treatment of this patient, which drug is most suitable (choose the most correct answer and explain your decision):
a) amoxicillin
b) clindamycin
c) doxycycline
d) linezolid
e) vancomycin
4. If this patient were to be treated with erythromycin she should (choose the most correct answer and explain your decision):
a) avoid exposure to sunlight
b) avoid taking supplementary iron tablets
c) decrease intake of caffeinated beverages
d) have her plasma urea nitrogen or creatinine checked before treatment
e) temporarily discontinue the antihistamine
5. A 5-days course of treatment for community acquired pneumonia would be effective in this patient with little risk of drug interactions if the drug prescribed were (choose the most correct answer and explain your decision):
a) ampicillin
b) azithromycin
c) chloramphenicol
d) tetracycline
e) vancomycine