Correct!
1. Admit and treat with piperacillin/tazobactam and doxycycline
The chest x-ray shows a right upper lobe consolidation which is compatible with CAP. A variety of protocols have been devised for determining admission for CAP. These include CURB-65 criteria (2). CURB-65 stands for Confusion; Blood Urea nitrogen greater than 7 mmol/L (19 mg/dL); Respiratory rate of 30 breaths per minute or greater; Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less; and age 65 or older. Each is given a point and those with 2 or more points should be admitted to the hospital.
The patient was admitted and treated with piperacillin/tazobactam and doxycycline but did not improve over the next several days with increased requirement for supplemental oxygen. A repeat chest x-ray showed worsening RUL consolidation (Figure 2).
Figure 2. Repeat chest x-ray 3 days after admission.
What should be done at this time? (Click on the correct answer to be directed to the fifth of seven pages)