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Step 3: Verify P-drug

Step 3: Verify P-drug. The 2010 CPG on CAP recommends the use of the following for MR-CAP: IV non-antipseudomonal β-lactam (BLIC, cephalosporin or carbapenem) + an extended macrolide OR IV non-antipseudomonal β-lactam + fluoroquinolone.

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Step 3: Verify P-drug

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  1. Step 3: Verify P-drug • The 2010 CPG on CAP recommends the use of the following for MR-CAP: • IV non-antipseudomonal β-lactam (BLIC, cephalosporin or carbapenem) + an extended macrolide OR • IV non-antipseudomonal β-lactam + fluoroquinolone

  2. Patient’s hypersensitivity to β-lactam antibiotics, however compels us to choose monotherapy using a respiratory fluoroquinolone such as levofloxacin or moxifloxacin

  3. Decision to chose Fluoroquinolone over an extended macrolide • A respiratory fluoroquinolone as monotherapy was chosen over an extended macrolide due to the severity of the patient's situation. • Presence of sepsis and concomittant uncontrolled diabetes in the patient compels us to choose a respiratory fluoroquinolone due to its stronger activity against the suspected pathogens.

  4. Decision to choose Levofloxacin over Moxifloxacin • Though Levofloxacin and Moxifloxacin shows equal efficacy in the treatment of CAP-MR, Levofloxacin is chosen due to its more affordable price.

  5. Dosage • Patient should be started with 750mg IV Levothyroxine q24 hour. • Assessment should be done after 3days so that parenteral therapy can be descalated to oral therapy once patient starts improving. • Nonresponse to therapy is an indication to examine Culture-Sensitivity of the etiologic agent and proper adminstration of adequate antimicrobial

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