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Infectious Diseases

Help 96 year old grandmother with pneumonia

05/23/2006

Question:

Dearest Doctor,

Good Day! I have a Grandmother who is 96 years old, staying in the ICU for more than a month at the moment. She has an irregular heart beat, causing fluid to enter her lungs. Her kidney seems to have malfunctioned as well. Her output is less than her input. Due to her heart and kidney malfunction, all the water is stuck in her body, most especially in the lungs. Now, she has an artificial respirator to help her breath.

To help prolong her life, it has been 1 month since my grandmother has been using lasix to help her urinate. Although, her urine output is still insufficient, she is still using this medicine to help her urinate. The following are the antibiotics that my Grandmother has been using for the past month: Tazacin 1gm; Rocephia 1gm; and Trinam 1g. She also takes albumin and can finish two boxes in one day.

But just last week, her doctors realized that she may have hospital acquired pneumonia. And now, since she has symptoms of pneumonia, her doctor has stopped the previous antibiotics and changed it to the following: Cepirmax 1g; and Deflucan 200mg.

According to her doctors, if the latter two antibiotics do not get her better, there is no other way to improve her situation. They do not know of any other antibiotics. Since your country is much more intelligent than ours and frankly, you have greater knowledge than the doctors here, is it possible that you suggest possible antibiotics that could help her improve her situation?

I really hope to hear from you. Your kindness and insights would help us a lot. I hope you could help us.

Answer:

Hospital acquired pneumonias can be related to pseudomonas infection. We usually use double coverage with 2 antibiotics a 3rd generation cephalosporin and an aminoglycoside/ or a fluoroquinolone to cover this organism till cultures are available to guide us in our antibiotic selections. 

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Response by:

Pamposh   Kaul, MD Pamposh Kaul, MD
Assistant Professor
College of Medicine
University of Cincinnati