Question: Please consider this to be a hypothetical scenario. Suppose an elderly pt is admitted to hospital with a minor
fracture that makes it too painful to walk. The pt recently suffered
pneumonia and is discovered on admission to have a high white cell count and a high
C reactive protein count. Initial CRP readings are 34.8, 71.3 146.7 & 279.1; while initial WCC readings are 14.4, 17.3, 16.1 & 26.0. There is a suspicion of a recurrence of pneumonia (although 2 blood cultures are negative and there is no urine analysis). The pt is administered IV
ceftriaxone for 10 days and, when that is ceased, administered
ciprofloxacin and
metronidazole. There is evidence that the pneumonia has cleared or is clearing (although there is an on-going problem with
pleural effusion). The administration of all antibiotics is then ceased, even though the CRP and WCC are still high. The recent CRP readings are 33.2, 26.3, 23.9 & 23.6; and the WCC readings are 19.5, 14.3, 15.9 & 13.7. After the cessation of antibiotics the CRP readings continue to be high at 30.5, 37.8, 54.3, 66, 110 & 126.9; while the WCC readings are now 15.6, 14.4, 13.5, 12.7 and 16.7. The antibiotics seem to have helped with the pneumonia but considering that the CRP and WCC were high at the time that the administration of antibiotics ceased and continued to be high, would it be best to have kept the pt on antibiotics (whether the same or different ones) or would it appear to be pointless considering their lack of success in resolving the high CRP and high WCC? What would you do in these circumstances?