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1、InhaledAntibioticsin CysticFibrosisByTonyS.Poteat,M.D.ResidentGrandRoundsNovember24,1998CasePresentationHPI:41yoWMwithcysticfibrosispresentswithasevendayhistoryofincreasedshortnessofbreathanddiaphoresis.Increasedsputumproduction.Sputumisthickerandisnowgreen.Hereports
2、noncompliancewithhispulmozymeandflovent.CasePresentationHehadfinishedhis28daycourseofinhaledtobramycin7dayspriortoadmission.PMH:Cysticfibrosisdiagnosedatage28.NasalpolypsAll:TetracyclineCasePresentationMedications:Inhaledtobramycin300mgb.i.d.for28daysthenofffor28days
3、.Ventolin3puffst.i.d.Flovent2puffsb.i.d.Serevent2puffsb.i.d.Pulmozyme2.5mgnebulizedq.d.Homeoxygen3Lbynasalcannula.Pancreaticenzymeswitheachmeal.CasePresentationSH:10packyearhistoryoftobacco,quitatage28.Occasionalredwine.Disabilitysince3/95,wasanautotechnician.ROS:Pat
4、ientfeelsthathehaslost5-10poundsoverthelastmonth.CasePresentationPE:Vitals95.9/107/25/133/90Gen:AnxiousWMinmildrespiratorydistress.HEENT:NC/AT,EOMI,PERRL,OPclearNeck:Supple,nolymphadenopathyCasePresentationCV:tachycardicnomurmur,rubs,orgallopsLungs:Cracklesintheleftb
5、ase,decreasedbreathsoundsandwheezesbilaterallyAbd:BenignExt:Clubbinginallextremities,noedemaCasePresentationLabs:15.317.941671%segs18%lymphs10%monosSMAC:WNLABG:7.406/49/49/30/83%on3LCasePresentationCXR:Cysticchanges,peribronchialthickening,nofocalinfiltrates.Sputumcu
6、lturefrom4monthsearliergrew4+PseudomonasaeruginosasensitivetoZosyn.Spirometryfrom4monthsearliershowedanFEV1of18%predictedandaFVCof45%predicted.CasePresentationHospitalCourse:Thepatient’ssatsimprovedon60%faceshieldandaggressivebronchodilators,andhewasadmittedto8RT.Hew
7、asbegunonIVZosyn,Cipro,steroids,inhaledTobramycin,nebulizedbronchodilators,andposturaldrainage.Bloodandsputumculturesweresent.Pediatricpulmonologywasconsultedandrecommendedcontinuingtheantibiotics,obtaininganutritionconsultandabreathingplusconsult.Hissputumgrewout4+P
8、seudomonasaeruginosasensitivetothecurrentantibiotics.Hecontinuedtoimproveandhisoxygendemandsreturnedtobaseline.Hewasdischargedafter
