[zacarias]

Hey all,

Question: I had a 94 y/o LOL last night who was in for chf r/o pneumonia. She was afebrile until about 2230 when she was shivering and shaking quite a bit. I took her temp to reveal 103.3! Poor thing, anyway, we got blood cultures but my question is, she already had Rocephin and Zithromax in the ER earlier and I'm wondering, is it possible for those to be the right abx but that she's still febrile at times?? Put another way, how long do docs wait before they change the abx or go another route? Thanks!

[TazziRN]

They usually don't change them until the cultures come back, or if they do they choose a stronger broad-spectrum pending cultures.

[Suesquatch]

I have one old one who had the above plus vomiting in reaction to amoxicillin - an allergy he'd never before had.

[southern rn]

One dose of each antbx would not prevent her from developing a fever. Antbx therapy is given for several days; if she came in with pneumonia she still had it and I would expect temps at times. Suprised that blood cultures weren't done in ER before antbx therapy was initiated, though.

[TazziRN]

Whoops.... I didn't catch that the cultures were obtained by the floor. I assumed the ER had done them too.

[MS._Jen_RN]

Yeah, cultures before abx is a standard of care. She could be having a febrile drug reaction, but more likely what the other posters said.
~Jen

[gina gina]

Hi Just Wanted To Let U Know.suggest That Doc Give Pt Children's Motrin Liquid Form To Bring Temp Down As First Priority.to Hell With Anything Else At The Moment Becuz U Never Want A Pt To Get A Temp So High That They Will Have A Seizure.the Pt Can B 1-100 Yrs Old,everybody Is Different When It Comes To Taking Antibiotics.

[adrienurse]

The person is a frail 94 year old therefore is fragile and will not necessarily repond to a treatment or an infection the same way as a healthier person. In short, she is very sick and is most likely septic, then there's the CHF. Frail people get very sick when they have infection and sometimes have dramatic responses before they start to get better.

[crissrn27]

I would be freaking out with a 94 y/o with a fever that high. They just don't run fevers that high unless something is very very wrong! (usually) I would think they are septic with the info you gave. Probably Zith and Rochepin are the best choices for right now, until you have cultures back or more info. Good broad spectrum's. Did they do cultures in the ER before ABT tx? Or just on the floor?

[kmoonshine]

Rocephin is a very good antibiotic with bactericidal properties (kills bacteria). Azythromycin, on the other hand, is bacteriostatic (stops bacteria from growing, but doesn't kill it; your immune system needs to kill it).

Antibiotics take time to work. Sometimes fluid in the lungs can cause a fever, which may have compounded the original fever. I've had patients who can drop their fever by coughing, deep breathing, and using an incentive spirometer.

Did you take a rectal temp and try another device to make sure it was accurate?

Make sure the patient has their fluid balance monitored and labs checked frequently (sodium, potassium, BNP, etc), especially if the patient is on a diuretic.