Case Study: Mr. M, 61-Year-Old Male at Outpatient Post-Hospital Follow-Up

Mr. M Case Study

The discovery of antibiotics marked a significant developmental milestone in medicine, resulting in better control and prevention of infectious disease. Antibiotics have helped populations over the years by reducing infectious disease burden and hence improving quality of life for the global community. However, recent misuses and overuse of antibiotics contribute to antibiotic resistance (Muteeb et al., 2023). The occurrence of antibiotic resistance is associated with compromised patient care, increased patient and case mortality rates, coupled with an ever rising healthcare expenditure (Muteeb et al., 2023). The race to overcome antibiotic resistance through continued antibiotic research is economically challenging given the nature and intensity of research and resources required for antibiotic development. Subsequently, various major pharmaceutical companies have pulled out of the race for antibiotic research and development, resulting in emerging gaps between antibiotic resistant strains emergence and the spectrum of antibiotics that are effective against these multi-drug resistant organisms (Muteeb et al., 2023). Therefore, to curb the spread of this crisis in infectious diseases treatment, it is crucial to practice effective antibiotic stewardship. Therefore, this paper will summarize crucial aspects in antibiotic stewardship within a case study discussion.

Chronic Obstructive Pulmonary Disease (COPD) is respiratory disease that is highly debilitating to the patients due to the progressive nature of the disease. The presence of thick mucus lining the respiratory tract provides a conducive environment for the development of bacteria resulting in numerous bouts of pneumonias that are difficult to treat. These infections require adequate antimicrobial use to avoid resistance. That said, it was wrong for Mr. M to receive multiple antibiotics for COPD in the last three months. The patient should have had their antibiotic selected based on the causative organism’s sensitivity pattern and other measures used to curb the adverse effects of the primary antibiotics such as the administration of probiotics to prevent diarrhea.

Some of the factors that increased Mr. M’s risk for antibiotic resistance include the improper use of antibiotics. The patient did not complete either course of the two antibiotics prescribed. The choice of antibiotics was also no guided by infecting organism’s antibiotic sensitivity patterns. Therefore, the diagnostic tests that should have been done to help the practitioner identify the causative organism and guide proper antibiotic choice and use are sputum microscopy, culture, and antibiotic sensitivity testing. Blood cultures and sputum for geneXpert and rimfapicin sensitivity should also have been done in cases of severe infections and to rule out tuberculosis as the cause of the persistent and prolonged history of productive cough seen in the patient. Antibiotics sensitivity testing is the gold standard to identifying multi-drug resistant organisms and to guide proper choice of antibiotics to prevent the development of antibiotic resistance or suboptimal management of infectious diseases.

The use of multiple antibiotics in the last few months predisposing Mr. M to opportunistic or antibiotics use-associated infections. The example is chronic diarrhea by organisms that would otherwise not infect an immunocompetent individual as a result of the antibiotic-induced clearance of normal flora from the gastrointestinal tract. The most common infecting organisms are fungi, more so the yeast forms lie Candida albicans and other bacteria like Clostridium difficile which causes antibiotic-induced pseudomembranous colitis (Jagirdhar & Surani, 2023). Pseudomembranous colitis is a severe infection of the colon caused by the bacteria Clostridium difficile after prolonged antibiotic use (Jagirdhar & Surani, 2023). The bacteria releases toxins that damage the colon epithelial lining and lead to the development of yellow-white membranous plaques lining the mucosal surface of the colon (Jagirdhar & Surani, 2023). The disease is associated with serious complications such as colonic perforation with peritonitis and septic shock and has high mortality rates more so in frail patients like Mr. M (Jagirdhar & Surani, 2023). Therefore, misuse or overuse of antibiotics like in the case study could lead to severe diseases causes by opportunistic infections. Mr. M is a 61-year-old male that presented to your outpatient clinic for a follow-up visit after being diagnosed with acute exacerbation of COPD

Finally, patient education on antibiotic stewardship is associated with reduced antibiotic prescribing and higher levels of patient satisfaction (Havlicek & Muhsin, 2023). Patient education and the provision of printed patient information cards could help avoid misuse and overuse of antibiotics. Therefore, to enhance appropriate use of antibiotics, I would educate Mr. M to ensure that they take their medication as prescribed and always aim to complete the doses as prescribed. I would educate the patient that not all diseases are caused by bacterial pathogens and hence not all diseases should be treated with antibiotics. Lastly, I would encourage them to undergo proper testing to ascertain the causes of their disease and avoid purchasing antibiotics over-the-counter without proper prescriptions with rationales by a healthcare provider.

References

Havlicek, L. K., & Muhsin, A. (2023). Can antibiotic stewardship be achieved by utilizing the stewardship through educating patients (S.T.E.P.) process? Cureus , 15 (10), e47992. https://doi.org/10.7759%2Fcureus.47992

Jagirdhar, K. S. G., & Surani, S. (2023). Non-clostridium difficile induced pseudomembranous colitis. World Journal of Clinical Cases , 11 (5), 979-988. https://doi.org/10.12998%2Fwjcc.v11.i5.979

Muteeb, G., Rehman, T., Shahwan, M., Aatif, M. (2023). Origin of antibiotics and antibiotic resistance, and their impact on drug development: A narrative review. Pharmaceuticals (Basel) , 16 (11), 1615. https://doi.org/10.3390%2Fph16111615 Mr. M is a 61-year-old male that presented to your outpatient clinic for a follow-up visit after being diagnosed with acute exacerbation of COPD

Mr. M is a 61-year-old male that presented to your outpatient clinic for a follow-up visit after being diagnosed with acute exacerbation of COPD. Patient reports that he is feeling better, however continues to endorse productive cough with clear sputum. Patient reports that he has been taking Doxycycline 100mg twice a day for the past one month. He reports taking Augmentin about two months prior to starting Doxycycline and had to stop because he started having diarrhea which has persisted for the last three months. He confirms not completing the Doxycycline prescription due to the diarrhea and insomnia. He has also been taking Benadryl 50mg every night for sleep. He stated that the Benadryl has helped with sleep; however, it makes him drowsy in the morning and he has noticed that he is not able to empty his bladder fully when he goes to the bathroom. Mr. M is concerned about these medical issues as he presents to your outpatient clinic. His medical history includes Diabetes Mellitus type 2, Hypertension, Hyperlipidemia, and COPD.

After your readings on antibiotic stewardship, answer the following questions thoughtfully, using citations from the article and the CDC website

Do you think Mr. M should have received multiple antibiotics for COPD in the last three months? What are some of the factors that make Mr. M at risk for antibiotic resistance from his history?

What diagnostic tests do you believe should be done that would have helped the practitioner identify the organism causing the infection and guide the proper use of antibiotics?

Discuss the other disease processes Mr. M is at risk for due to having multiple antibiotics in the last few months.

As the nurse practitioner taking care of Mr. M, what patient education would you provide on the use of antibiotics?

Mr. M is a 61-year-old male that presented to your outpatient clinic for a follow-up visit after being diagnosed with acute exacerbation of COPD