Less is more: fatal C. difficile colitis after empiric antibiotics

Aspiration pneumonitis 4 out of 5 stars Antibiotics “Just-In-Case” in a Patient With Aspiration Pneumonitis. Joundi RA et al. JAMA Intern Med 2015 Apr 1;175:489-490 Reference This very brief but very important case report contains more key points than most papers 10 times as long. The case describes a 50-year-old man with cerebral palsy and a known seizure disorder who had several witnessed tonic-clonic seizure episodes treated with a benzodiazepine. Subsequent chest x-ray revealed multiple bibasilar opacities consistent with aspiration. The patient was started on piperacillin-tazobactam. Although he showed significant clinical improvement on the second hospital day, the antibiotics were continued for a full 7-day course because of the “possibility” of aspiration pneumonia. The patient was discharged in good condition after 10 days in hospital, but returned a week later with diarrhea, shock, and an increased white blood cell count. Work-up revealed Clostridium difficile colitis. Despite medical treatment, he succumbed to the infection on hospital day 18. In their cogent discussion, the authors point out the differences between aspiration pneumonitis and aspiration pneumonia: Aspiration pneumonitis is an acute chemical caustic lung injury that begins abruptly — often after a witnessed seizure — and generally improves within 48 hours. Treatment generally consists of supportive care without antibiotics. In approximately 1 in 4 of these patients bacte...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical adverse drug event aspiration pneumonia aspiration pneumonitis clostridium difficile colitis Source Type: news