Antibiotic Stewardship in a Pediatric Patient with Pneumonia

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Explore appropriate antibiotic selection, dosing, and resistance concerns in pediatric care.

Patient Profile:

Age: 6
Gender: Female
Weight: 44 lbs (20 kg)
Medical History: Recurrent ear infections, no known drug allergies
Current Medications: None
Diagnosis: Community-Acquired Pneumonia (CAP)
Instructions for Students:

Identify the most likely pathogens causing pneumonia in this age group and discuss antibiotic options.
Select an appropriate antibiotic regimen, including dosing, route, and frequency, based on guidelines for pediatric CAP.
Evaluate the risk of antibiotic resistance and the importance of antibiotic stewardship in this case.
Monitor: Define what clinical signs/symptoms and laboratory findings should be monitored to ensure the therapy is effective.
Adjust: Outline any considerations if the patient fails to respond to first-line therapy or develops adverse effects.
Counsel: Provide key teaching points for parents on the correct use of antibiotics, potential side effects, and the importance of completing the prescribed course.

Sample solution

Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell. 

In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.

God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.

Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.

To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.

References

Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.

Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.

Summary of Key Points:

  • Likely Pathogens:
    • Streptococcus pneumoniae (most prevalent)
    • Mycoplasma pneumoniae
    • Chlamydophila pneumoniae
    • Viruses
  • Antibiotic Regimen:
    • First-line: High-dose amoxicillin (90 mg/kg/day, oral, divided into two doses).
    • Alternatives: Amoxicillin-clavulanate, macrolides, ceftriaxone (for severe cases).
  • Antibiotic Resistance:
    • Recurrent ear infections heighten the risk of resistant pathogens.
    • Strict antibiotic stewardship is essential.
  • Monitoring:
    • Clinical improvement: Fever reduction, respiratory ease, etc.
    • Laboratory: White blood cell counts, chest X-ray findings.

Summary of Key Points:

  • Likely Pathogens:
    • Streptococcus pneumoniae (most prevalent)
    • Mycoplasma pneumoniae
    • Chlamydophila pneumoniae
    • Viruses
  • Antibiotic Regimen:
    • First-line: High-dose amoxicillin (90 mg/kg/day, oral, divided into two doses).
    • Alternatives: Amoxicillin-clavulanate, macrolides, ceftriaxone (for severe cases).
  • Antibiotic Resistance:
    • Recurrent ear infections heighten the risk of resistant pathogens.
    • Strict antibiotic stewardship is essential.
  • Monitoring:
    • Clinical improvement: Fever reduction, respiratory ease, etc.
    • Laboratory: White blood cell counts, chest X-ray findings.
  • Adjustments:
    • No response: Consider resistance, atypical pneumonia, complications, or need for IV therapy.
    • Adverse effects: Switch antibiotics.
  • Counseling:
    • Adherence: Complete the antibiotic course.
    • Side effects: Inform parents of potential side effects.
    • Appropriate usage: Explain that antibiotics are not effective against viruses.
    • Proper dosing, and frequency of use.

Emphasis on this Patient’s Factors:

  • Recurrent Ear Infections:
    • This is a red flag. It significantly increases the probability of antibiotic-resistant S. pneumoniae. While amoxicillin is still a first line treatment, very close observation of the patients progress is extremely important.
    • If there is no improvement within 48-72 hours, a change to a broader spectrum antibiotic should be considered.
  • Weight-Based Dosing:
    • Accurate weight-based dosing is critical in children. Any errors in calculation could reduce the effectiveness of treatment, or increase the likelyhood of side effects.
  • Parental Education:
    • With recurrent infections in their child, the parents need to understand the extreme importance of antibiotic compliance, and that they need to finish the complete course of antibiotics.

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