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Suggest Treatment For Respiratory Critical Illness Neuropathy And Infection Caused By Serratia Marcescens

Posted on Tue, 18 Nov 2014

Question: My father is suffering from critical illness neuropathy and is bedridden...one of the main difficulties is getting rid ofrerespiratory infection as he has undergone tracheostomy and uses a traech tube for breathing...latest he has respiratory infection caused by serratia marcescens...we have given him livofloxacin for 7 days...also given Amikacin and Ceftriaxone but the infection is still there...the culture report showed that the growth was moderate and the organisms was sensitive to above antibootics....pls advise further treatment....

Answered by Dr. Rakesh Madhyastha (4 hours later)

Brief Answer:
Need more info

Detailed Answer:
Hello

Thanks for the query

I am sorry that your father is in this condition. However in order to help you better I need more information

1. With what complaints did he approach the hospital?
2. Was he on ventilator in the ICU?
3. Have you taken a chest x ray? If so please attach the report
4. You have attached the urine report. Can you please attach the sputum culture report along with complete blood count report ( if it was done).
5. From when is he bed ridden? Are there any bedsores?

Please get back to me, I am awaiting your reply

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (7 hours later)

1. He had a ruptured apendicitis which led to septicimia and other related complications like ARF...that was 7 months ago...he stayed in ICU for 3 months...since last 4 months he is at home and without any ventilator or oxygen support...his back is fine and there are no bedsores...his chest is clear as examined by the physician...attaching the sputum culture report...we are doing only TLC and it is 15600 as of yesterday...he has completed 7 days of livofloxacin and is on 5th day of amikacin and monocef...

Answered by Dr. Rakesh Madhyastha (6 hours later)

Brief Answer:
Treat aggressively

Detailed Answer:
Hello

Thanks for getting back with the reports.

The fact that the total count is 15,600 means that there is an active infection. Culture report is sensitive to most antibiotics, considering the bed ridden status and prolonged course of hospital stay I would prefer him to be on Meropenem and amikacin instead of monocef. It is a clinical decision but even according to studies Meropenem is the drug of choice, please approach your physician with my suggestion.
I would like to add here that Amikacin is Nephrotoxic so please get S creatinine levels checked once in 5 days.

I hope I was of help, if you have any further queries please get back to me

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (28 minutes later)

We have been constantly fighting infection since last 7 months and meropenem was used on seceral occasions for different organisms...this time we thought that we should try some cheaper options as well as cost of meropenem is more than ten times of other antibiotics. ..also the patient had low grade fever only and did not have any hypotension or tachycardia as in case of earlier infections which were more severe in nature...I wud basically want to know wat are the other cost effective options other than meropenem..wat are the chances with bactrim or any fourth generation cephalosporins....

Answered by Dr. Rakesh Madhyastha (19 minutes later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back

You are right, Meropenem is a very expensive. Bactrim is not very effective for an respiratory infection.
Your cheaper options are

1. Pipercillin with Tazobactum
2. Levoflox
3. Cefipime is a great option, but is as expensive as Meropenem

3rd generation Cephelosporin life ceftriaxone or Cefotaxim are also good options.

Along with the above measures I recommend

1. Chest physiotherapy
2. Mucomix nebulisations thrice a day
3. Keep the patient is propped up position
4. Mobilize the patient as much as possible, especially on a wheel chair in sunlight
5. Avoid steroids as much as possible

I hope I was of help

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (18 minutes later)

Thanks for the answer...wat is the advantage of keeping him in propped up position. ..also pls advise why steroids are to be avoided...he is taking steroids for his neuropathy treatment...I guess omnacortil...

Answered by Dr. Rakesh Madhyastha (29 minutes later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Propped up position in bed ridden patients helps to prevent aspiration and also secretions going into the trachea.

Steroids are to be avoided as it might worsen the infection making it more difficult to treat. It reduces immunity. Studies have shown increased mortality in patients receiving steroids than patients not on steroids.

I hope I was of help

Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar