Final answer:
First-line antibiotics for high-risk CAP patients include ß-Lactams, with macrolides and fluoroquinolones as alternatives. Antibiotic resistance is a concern, and broad-spectrum antibiotics may be needed. Vaccines against pneumococcal diseases are important preventatives.
Step-by-step explanation:
The first-line antibiotics for non-healthy (high-risk) patients with community-acquired pneumonia (CAP) typically include ß-Lactams such as penicillin. However, due to increasing resistance to these drugs, alternative options like macrolides (for example, azithromycin) and fluoroquinolones may also be prescribed. It is crucial to consider antibiotic resistance patterns in the local area when selecting treatment. When ß-lactam resistance is of concern, or if initial treatment with ß-lactams like amoxicillin is unsuccessful, a macrolide or fluoroquinolone may be more effective, as in the case study where Barbara's symptoms resolved after switching to azithromycin.
In situations where patients do not respond to prescribed antibiotics, causes other than bacteremia, such as viral, fungal, or antibiotic-resistant bacterial infections, should be considered. For high-risk patients with a significant likelihood of encountering resistant bacterial strains, broad-spectrum antibiotics such as levofloxacin or cefotaxime might be employed.
Two pneumococcal vaccines, PCV13 and PPSV23, are available to protect the most vulnerable populations, such as young children and older adults, against pneumococcal diseases. Vaccination can substantially reduce the risk of infection.