Brief Answer:
Please see below

Detailed Answer:
Hello,
Thank you for your query.

Would you please clarify a few things for me?
-did she have any exposure to someone with a respiratory tract infection recently?
-how long has she been diabetic? What medications is she on?
-any other medical issues? Medications?
-does she have cough? What colour is the sputum or phlegm?
-did she choke on her food anytime before this started?
-did the doctor evaluate her heart?

I recommend :
-continue antibiotics and supportive medications
-sputum culture and sensitivity to see if she is getting the right antibiotic (may take 3-5days to be reported). It is vital to do this ASAP
-repeat chest x-ray and complete blood count after 5 - 7 days of treatment.
-an electrocardiogram and echocardiogram
-blood tests (kidney function tests, HbA1c, fasting blood sugar, electrolytes) and urine test
- vitamin c supplement 500mg twice a day (if she doesn't have gastritis)
-frequent and good chest physiotherapy to help loosen the secretions and heal faster (4 times a day)
-steam inhalations thrice a day
-breathing exercises and XXXXXXX meter exercises when she is up to it, to prevent airway collapse.

Diet - normal but nutritious. Smaller but frequent meals help maintain energy throughout the day. Include proteins, fresh fruits, vegetables.
Keep her well hydrated. This is very important as thick mucus will take a longer time to come out and delay healing.
Please consult her doctor to see if she needs any fluid restrictions.
If not, give her plenty of warm water.
Garlic is a natural Mucolytic, so include more of it her diet.

Hope this helps.
Please let me know if there is anything else I can help you with.
Wish you both good health

Regards,
Dr Shuba Hariprasad

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Brief Answer:
Cause of vomiting? Aspiration pneumonia?

Detailed Answer:
Hello,
Thank you for the follow up

*why did she vomit? Did she have loose motion as well?
*has a CT scan of the brain been done?
*how is her level of consciousness now? Does she talk and communicate? Can she move her arms and legs to some extent?
*is she currently at home or hospital?
*does she require oxygen now?

Judgements of Improvement would be based on her clinical status and changes and resolution of the infection.
As her temperature is going down, the treatment seems to be working. However, that alone cannot confirm improvement.

Ways to check her improvement :
-no fever
-normalizing white blood cell counts
-returning to previous level of activity before she contracted pneumonia
-breathing normally without any additional oxygen and support.
These all show improvement along with positive clinical findings.

My concern is if she breathed in/aspirated some of the vomit particles, which could have caused the pneumonia.
If it is so, I would like to add an additional antibiotic - Inj. Metronidazole 500mg thrice a day. This may have side effects of vomiting and appropriate measures (anti-emetic drugs) must be given prior to administration of this.
The cause of vomiting should be evaluated as well. I recommend :
-CT scan of the brain
-liver function tests.

Please talk to your doctor as he is in the best position to judge the other problems.

Hope this helps.
Please let me know if there is anything else I can help you with
Regards,
Dr. Shuba Hariprasad

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Brief Answer:
Not yet recovered

Detailed Answer:
Hello,
Thank you for the follow up
*did they repeat a chest x-ray today?
*is she on any oxygen support?if yes, how much and what type
*is she able to breathe better? Talking? Eating?
Her doctor will be able to answer some of the above questions.

Based on her reports, her infection seems to be getting better but that alone cannot be reliable. The above questions will help me analyze the clinical status better.

Her platelets are reducing and is on the lower side. This could be due to the infection. It usually resolves and doesn't need additional treatment unless it becomes too low and she has bleeding problems,in which case she will need platelet transfusion.

Fever indicates that infection is still persistent.
Have they done a sputum culture test? I recommend a repeat culture.

She is still not completely out of the Infection. Please get back to me with the requested information so that I may help you better

Hope this helps.
Please let me know if there is anything else I can help you with.

Regards,
Dr. Shuba Hariprasad

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Brief Answer:
Please don't worry

Detailed Answer:
Hello,
Piperacillin /tazobactam (piperataz) is one of the top antibiotics. They must have given this because the infection is still persistent.
You did not mention if they have done a sputum culture.

As she does not require any oxygen and is breathing normally, there is no immediate threat to life.
A severe infection takes a toll on the body. It will r are time for her to heal
I recommend :
:sputum culture if not already done
:repeat chest x-ray after 3 days of the new antibiotic
:repeat wbc and platelet count in two days
: chest physio therapy (after consulting her doctor). This helps to loosen secretions and promote healing.
: nebulizations as required

I understand your concern. Please give her time. Usually persistent infections are treated based on the culture reports and the response to treatment.
As the medications has been changed, it will take 48 hrs to see the effect. Let us wait and see how she feels after 2 days (if her fever comes down and the wbc continue to reduce).

Please monitor her urine output as well. It should be a east 1.2 liters a day, depending on her weight.

Hope this helps and reassures you.
Please let me know if there is anything else I can help you with.
Kind regards,
Dr. Shuba Hariprasad

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Brief Answer:
Continue antibiotics for 5 more days

Detailed Answer:
Hello,
Thank you for the follow up.

I recommend :
-continuing piperataz for 5 more days or till afebrile (no fever) for 48 hours. Even an appropriate (based on sputum culture reports) oral antibiotic will do.
Please send culture reports so that I may advice accordingly.
-continue chest physiotherapy, steam inhalations, nebulizations.
-don't give Cronin (fever medication) unless temperature is more than 100f. sometimes body can still react to the infection and inflammation due to it and result in fever.

To answer your query, the absence of Infection can be considered if the following criteria are met:
-absence of fever for more than 48 hrs
-normal breathing and oxygen levels
-clearing up of infection clinically and evidenced by x-ray of chest and lab reports

In this scenario, her doctor is the best judge. However, as she had a severe infection and is still febrile, I suggest continuing through antibiotics for another 5 days.

If fever still persists, a superimposed fungal or viral infection must be suspected and tested for.
Her blood values have normalized, so that is a positive sign.

Please consider my recommendations and let me know if there is anything else I can help you with.
Wish you all good health.
Regards,
Dr. Shuba Hariprasad

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