Knowledge of treatment for h1n1

[lamazeteacher]

Those of you who care for patients with H1N1, please post here what antibiotics you administer for them, that have been ordered for their coinfection with MRSA, strep, ecoli, fungus, etc.; and how soon after admission those antibiotics are administered. No need for great detail, or per patient rundown, just the name of the drug, frequency given, route, and dosage (with age of patient, if a child) are sufficient. I'll let you know how the findings come out, as far as their prevalence of early use is concerned.

If you know that another nurse with whom you work has already contributed for a case, just note in your post that you know that has already been done. You may have known more about that patient than the first poster. Due to that, some geographic information (city, state, hospital) would be helpful, too. No names of patients, please!

We all have a variety of pathological microorganisms on our persons that have been resisited by our bodies while healthy, which open to their destruction, whenever our health is compromised by virulent viruses and other organisms. I'm wondering if aggressive antibiotic treatment is started early enough, for H1N1 patients.....

previously healthy or otherwise. Of course if you know whether they had the H1N1 flu vaccine, that information is pertinent, as well as the use of antivirals and it would be very much appreciated if you added that to your contribution.

This will be a service allnurses.com can provide, due to the wealth of input we can access, and already do, such as our ages, opinions, experiences, etc.

[NRSKarenRN, BSN, RN]

while antidotal knowledge is important, see these published articles:

updated interim recommendations for the use of antiviral medications in the treatment and prevention of influenza for the 2009-2010 season

from medscape: influenza: follow-up

complications

• primary influenza pneumonia is characterized by progressive cough, dyspnea, and cyanosis following the initial presentation on the infection. chest radiographs show diffuse infiltrative patterns bilaterally, without consolidation, which can progress to a presentation similar to [color=#5757a6]acute respiratory distress syndrome. risks for [color=#004276]viral pneumonia involve numerous complex host immune responses and viral virulence. although elderly individuals, especially nursing home patients, and those with cardiovascular disease constitute the highest risk groups, do not forget that, in the 1918-1919 epidemic, many young adults died of a pneumonia that some experts believe was caused directly by the virus.
  
• secondary bacterial pneumonia can occur from numerous bacteria (eg, [color=#004276]staphylococcus aureus, [color=#004276]streptococcus pneumoniae, [color=#004276]haemophilus influenzae ).
  
  • the most dreaded complication is staphylococcal pneumonia, which develops 2-3 days following the initial presentation of viral pneumonia. patients appear severely ill, with hypoxemia, an elevated wbc count, productive bloody cough, and a chest radiograph showing multiple cavitary infiltrates. methicillin-susceptible s aureus ( mssa) and methicillin-resistant s aureus (mrsa) pneumonias have occurred following influenza pneumonia. mrsa pneumonia may be severe and difficult to treat, and deaths have occurred within 24 hours of presentation of pneumonia symptoms.
    
  • s pneumoniae or h influenzae pneumonia, if occurring as a complication, usually develops 2-3 weeks after the initial symptoms of influenza and can be managed as a [color=#004276]community-acquired pneumonia, following standard antibiotic and admission/discharge guidelines.
    

  [*][color=#004276]myositis is a rare complication. this group of patients may develop frank rhabdomyolysis, with elevated creatine kinase levels and myoglobinuria.

  [*][color=#004276]myocarditis and pericarditis have been associated with influenza infections

staphylococcal infections: treatment & medication

pneumococcal infections: treatment & medication

[lamazeteacher]

Karen RN:

Thanks so much for referring the articles in your post. They state already known treatment recommendations; and will be useful in evaluating the replies I hope will follow in this thread. While there will be some anecdotal quality in individual replies, it's not so much the experience of having H1N1 that interests me, as much as treatment patients received, in anticipation/empirical use of specific antibiotics for possible MRSA.

The reason MRSA concerns me so much, is the interval between admission to hospital and rapid decline in the conditions of many patients, leading sometimes to their deaths. Due to the profusion of lesser treatment modalities in some patients, that indicates the prevalence of tendancies to minimize the potential danger with H1N1. When that happens often, it's necessary to draw to nurses' attention, their role in encouraging PCPs to treat H1N1 aggressively.

With sufficient participation by members of allnurses.com, it might be possible to draw from the experiences contributed, the role played by nurses once they realize the seriousness of admitted patients' prognosis and need to include that in nursing care planning.