Flu and Pneumonia: Treatment Duration, Complications, and Concerns

Influenza, pneumonia, treatment duration, and complications?

Hello Doctor: My family member, a 46-year-old male, is experiencing a 40-degree fever due to influenza, along with pneumonia.
After screening, there is evidence of pulmonary infiltration, and his white blood cell count has spiked to 18,000.
He has been hospitalized for 6 days, and according to the doctor, the pneumonia is caused by either a viral or bacterial infection.
During this time, he has been taking Oseltamivir and receiving antibiotics.
He continues to experience fluctuating fevers, maintaining around 37-38 degrees Celsius without resolution.
His white blood cell count has decreased, but on the 6th day, an X-ray showed no improvement in pulmonary infiltration.

He has a history of diabetes and high urinary protein.
Today, the doctor changed his medication and administered Avelox (moxifloxacin) as an antibiotic, indicating that treatment will continue for another 5-7 days.
I would like to ask the doctor if prolonged antibiotic use could burden the body or kidneys.
How long is the expected treatment duration? With persistent fever and pulmonary infiltration, could prolonged illness lead to complications? What other precautions should be taken? Are there any good medications available for out-of-pocket purchase? Thank you, Doctor, for taking the time to respond.

Mr. Lin, 40~49 year old female. Ask Date: 2011/12/24

Dr. Jian Shuntian reply Pulmonology

Due to the complexity of the condition, a complete understanding may not be possible, and only simple questions can be addressed.
Further discussions with the attending physician may be necessary.
(1) The use of antibiotics is partially metabolized by the kidneys, depending on the specific antibiotic, which may impose a burden.
However, if necessary, the physician will monitor kidney function and use them cautiously.
(2) Antibiotic treatment has a certain efficacy, determined by the condition, typically lasting 7-14 days but possibly longer.
(3) Pneumonia can have various complications, such as pleural effusion, lung abscess, empyema, hematuria, and sepsis, which need to be discussed further with the attending physician.
(4) Most medications are currently covered, depending on their necessity; please communicate with the attending physician to understand the next steps.
Thank you for your inquiry, and I wish you good health.
Sincerely, Dr.
Chien Shun-Tien, Department of Thoracic Medicine.

Reply Date: 2011/12/24

More Info

When dealing with flu and pneumonia, especially in a patient with underlying conditions such as diabetes and proteinuria, it is crucial to understand the treatment duration, potential complications, and necessary precautions.
In your case, the patient has been hospitalized for six days, receiving antiviral medication (likely oseltamivir, commonly known as Tamiflu) and antibiotics. The presence of high white blood cell counts and lung infiltrates suggests a significant infection, which may be either viral or bacterial in nature. The fact that the fever persists, fluctuating between 37-38 degrees Celsius, indicates that the body is still fighting the infection, and the treatment may need to be adjusted based on the response observed.

Antibiotics like Avelox (moxifloxacin) are often used to treat bacterial pneumonia, especially when the initial antibiotic regimen does not yield improvement. It is essential to monitor the patient's response to this new antibiotic closely. The duration of antibiotic therapy can vary, but typically, a course of 5-7 days is standard for uncomplicated pneumonia. However, in cases of complicated pneumonia or when the patient has comorbidities, treatment may need to be extended.

Regarding your concern about the long-term use of antibiotics and their impact on the kidneys, it is valid. While Avelox is generally well-tolerated, prolonged use of any antibiotic can lead to side effects, including potential kidney damage, especially in patients with pre-existing renal issues. Regular monitoring of kidney function through blood tests (like serum creatinine and electrolytes) is advisable during treatment.
As for complications, untreated or inadequately treated pneumonia can lead to serious issues such as lung abscesses, pleural effusion, or sepsis, particularly in patients with underlying health conditions. The persistence of fever and lung infiltrates is concerning and warrants close observation. If the patient's condition does not improve with the current treatment, further diagnostic imaging or even a consultation with a pulmonologist may be necessary.

In terms of medications that can be purchased out-of-pocket, it is essential to consult with the treating physician before introducing any new medications or supplements. Some over-the-counter options, like expectorants or cough suppressants, may provide symptomatic relief, but they do not treat the underlying infection.
In summary, the treatment of pneumonia, particularly in a patient with additional health concerns, requires careful management and monitoring. The duration of treatment may extend beyond the initial 5-7 days if the patient does not show significant improvement. It is crucial to maintain open communication with the healthcare team, report any new symptoms, and ensure regular follow-ups to prevent complications.

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