Author Question: Antibiotic Usage

Amanda Asks:

I thought it would be good conflict to give my nurse protagonist TWO patients with rival needs. The fast facts:

A) Fugitives from the law.
B) No access to medical treatment.
C) The nurse does have some Amoxicillin but just enough for about another week for Patient #1 (the man she loves), who has been on it for almost five days now (fever broke, lucid now, still sick though.) He has bacterial pneumonia, rib fractures, and malnourishment.

They’re running for their freedom if not their lives. In comes Patient #2, who dug a tracking device out of his body with a non-sterile instrument and now has cellulitis (red streaks from the wound, low-grade fever, awesomeness.)

My nurse has to give him antibiotics or he could die.

But if she gives them to Patient #2, Patient #1 could relapse. And die.

So . . . Nurse Jordyn . . . which patient truly needs the medicine the most? Is there any use whatsoever in giving each of them half of it?

If she gives the whole dose left to Patient #2, will Patient #1 necessarily relapse? Is it unrealistic if he doesn’t?

If she gives the whole dose left to Patient #1 will Patient #2 necessarily die?

And now for the big question: as a nurse, what would YOU do?

Thank you, you are awesomely awesome.

Jordyn Says:

Wow, Amanda. This is a very intense question and not as hard an answer as you might think.

The issue you’ve given these two patients . . . Patient #1 has presumed bacterial pneumonia because I’m assuming no chest film was taken (which would be a definitive diagnosis) since they are running from the law. Patient #2 has cellulitis. 

The reason this is an easy answer is that Amoxicillin is typically not used to treat skin infections. What is generally used is an antibiotic called Keflex. This uber-smart nurse would know that and continue to give the Amoxicillin to the man with the pneumonia– particularly if he was improving. If the patient improves it can be a logical assumption that the antibiotic had something to do with it and he should finish the course of treatment.

That being said— let’s consider your questions.

Is there a benefit in giving each half the dose? Yes and no. This could be effective and also dangerous. Under dosing an antibiotic could lead to partial treatment and some bacteria still being left alive. Now, the bacteria have been exposed to the antibiotic and may mutate leading to a resistant strain which could ultimately put them both in danger.

Would patient #1 die if treatment stopped half-way through? Again, yes and no. He could survive and be fine but also develop a more resistant infection later on.

Would patient #2 die without treatment? Yes, this is probable with a bad cellulitis. Likely, what would happen eventually, is the bacteria gets into his blood and he dies from blood-borne sepsis or blood poisoning as it is sometimes called.

I do hope one of these fine gents lives.

Medical Question: Pneumonia

Elaine asks: You’ve come highly recommended by quite a few author-friends and I’m hoping you can help me out with a medical question for my story.
I have a high school senior who comes down with a severe case of pneumonia weeks before her graduation. She is hospitalized in the ICU, pulls through, but doesn’t make it to graduation.

Plot wise I need her to miss the fall semester of beginning college & have her family keeping her home during the summer for extra rest while she recuperates more fully. I’d like to know if this scenario is feasible– that a case of pneumonia, if bad enough, could weaken someone enough that she’d postpone starting school in the fall and take it up again in the spring?

Jordyn says: Elaine—thanks so much for sending me your question. And thanks for the compliment! That means a lot to me.
As far as your question—there are a few issues with your scenario. In a previously healthy young adult, it wouldn’t be that feasible for her to be sick so long. Medical treatment for pneumonia is antibiotics for 5-10 days. Then maybe residual cough, easily fatigued for a couple of weeks. This is of course if it is a one-sided simple pneumonia. So, considering those factors, if she were sickened in May I would think she’d be able to attend school in the fall.
Also, people are rarely admitted to the ICU for pneumonia unless they need to be intubated on a breathing machine. So, say she had bilateral (both lungs involved) pneumonia, had to be intubated, popped a lung (called a pneumothorax), needed a chest tube, etc. Again, these might sicken her for a couple of weeks but if she’s generally healthy she should be able to overcome this, rest up for several weeks—back to school in the fall.
My suggestion would be this— give this character a chronic illness that puts her lungs in a more vulnerable state (broncho-pulmonary dysplasia, asthma, cystic fibrosis) and the pneumonia got to the point where she had to be admitted to the ICU on a ventilator and she blew a lung which complicated her situation. Considering her history of chronic disease—it would be more feasible that she’d have a long recovery time and she’d take the fall semester off.
Asthmatics on the ventilator are very hard to manage and get off and often have a complicated course. Most often, they have to be medically paralyzed and sedated. The patient is high risk for developing a pneumothorax. This would be my pick.

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Elaine Stock is a former RWA member and has presented several writing workshops. Presently involved in ACFW, she was a 2011 semi-finalist in the prestigious Genesis Contest in the contemporary fiction division. She is also active on several social networking groups. Her first short story was published on Christian Fiction Online Magazine. New to the blogging world, Elaine started a blog this past April, Everyone’s Story. Since then, the blog has been graced by an awesome international viewership that totally pings her heart. Everyone’s Story features weekly interviews and reflections from published authors, unpublished writers…and just about anyone who wants to share a motivating story with others that may lift their spirit. She has also been the guest of several other blogs, helping to further grow her presence on-line.

She and her husband make their home in an 1851 Rutland Railroad Station they painfully but lovingly restored.