Objective: Explore appropriate antibiotic selection, dosing, and resistance concerns in pediatric care.
Patient Profile:
Age: 6
Gender: Female
Weight: 44 lbs (20 kg)
Medical History: Recurrent ear infections, no known drug allergies
Current Medications: None
Diagnosis: Community-Acquired Pneumonia (CAP)
Instructions for Students:
Identify the most likely pathogens causing pneumonia in this age group and discuss antibiotic options.
Select an appropriate antibiotic regimen, including dosing, route, and frequency, based on guidelines for pediatric CAP.
Evaluate the risk of antibiotic resistance and the importance of antibiotic stewardship in this case.
Monitor: Define what clinical signs/symptoms and laboratory findings should be monitored to ensure the therapy is effective.
Adjust: Outline any considerations if the patient fails to respond to first-line therapy or develops adverse effects.
Counsel: Provide key teaching points for parents on the correct use of antibiotics, potential side effects, and the importance of completing the prescribed course.
Sample solution
Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell.
In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.
God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.
Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.
To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.
References
Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.
Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.
Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.
Sample Answer
Sample Answer
Pediatric Community-Acquired Pneumonia: Antibiotic Selection and Management
Pathogens Causing Community-Acquired Pneumonia (CAP) in Children
In children aged 5-11 years, the most common pathogens responsible for Community-Acquired Pneumonia (CAP) include:
1. Streptococcus pneumoniae
2. Mycoplasma pneumoniae (more common in older children)
3. Chlamydia pneumoniae
4. Viruses (such as respiratory syncytial virus (RSV) and influenza)
Given the patient’s age (6 years) and medical history of recurrent ear infections, Streptococcus pneumoniae is the most likely pathogen in this case.
Antibiotic Options
Based on current guidelines for pediatric CAP, the following antibiotic regimen is appropriate:
First-Line Antibiotic Regimen
– Antibiotic: Amoxicillin
– Dose: 90 mg/kg/day divided into two doses
– Route: Oral
– Frequency: Twice daily
– Duration: 7-10 days
Dosing Calculation
– Weight: 44 lbs = 20 kg
– Total daily dose: 90 mg/kg × 20 kg = 1800 mg/day
– Divided into two doses: 1800 mg/day ÷ 2 = 900 mg per dose (which can be rounded to the nearest available formulation of Amoxicillin).
Risk of Antibiotic Resistance and Importance of Stewardship
Antibiotic resistance is a significant concern in pediatric care, particularly with the overuse of broad-spectrum antibiotics. Key considerations include:
– Resistance Patterns: Increasing resistance of Streptococcus pneumoniae to penicillin and other antibiotics necessitates judicious use of antibiotics.
– Antibiotic Stewardship: Encouraging appropriate prescribing practices, such as using narrow-spectrum antibiotics when possible, is crucial. This helps minimize resistance development and preserves the effectiveness of existing antibiotics.
Monitoring
To ensure the effectiveness of the therapy, monitor the following clinical signs/symptoms and laboratory findings:
Clinical Signs/Symptoms
– Improvement in respiratory symptoms (e.g., cough, wheezing, shortness of breath)
– Decrease in fever and overall improvement in the child’s condition
– Normalization of oxygen saturation levels
Laboratory Findings
– Repeat chest X-ray if no clinical improvement after 48-72 hours to assess for complications (e.g., abscess or effusion)
– Monitor complete blood count (CBC) for signs of infection resolution or worsening
Adjustments if Therapy Fails or Adverse Effects Develop
If the patient fails to respond to first-line therapy or develops adverse effects, consider the following:
Failure to Respond
1. Reassess Diagnosis: Confirm that pneumonia is the correct diagnosis and evaluate for potential complications such as empyema or abscess.
2. Alternative Antibiotics: If Streptococcus pneumoniae resistance is suspected, consider transitioning to a broader-spectrum antibiotic such as:- Cefdinir: 14 mg/kg/day divided into two doses.
– Augmentin (Amoxicillin-Clavulanate): If there are concerns about atypical pathogens.
Adverse Effects
If the patient experiences gastrointestinal side effects (e.g., diarrhea, nausea), consider:
1. Symptomatic Management: Encourage hydration and monitor for dehydration.
2. Alternative Medications: If side effects are severe, switch to an alternative antibiotic with a better tolerability profile.
Counseling Points for Parents
1. Correct Use of Antibiotics:
– Emphasize the importance of administering the antibiotic exactly as prescribed (dosage and frequency).
– Explain that antibiotics should not be used for viral infections.
2. Potential Side Effects:
– Discuss common side effects such as gastrointestinal upset and allergic reactions.
– Advise parents to monitor for any new or concerning symptoms.
3. Completing the Course:
– Stress the importance of completing the full course of antibiotics, even if symptoms improve before finishing the medication.
– Explain that stopping antibiotics early can contribute to antibiotic resistance and treatment failure.
4. Follow-Up:
– Schedule a follow-up appointment to reassess the child’s condition within a week of starting antibiotics to ensure clinical improvement.
By adhering to these guidelines and considerations, we can optimize the management of pediatric community-acquired pneumonia while mitigating risks associated with antibiotic resistance.
