Community-acquired pneumonia in a penicillin-allergic patient taking warfarin
Write a prescription for community-acquired pneumonia, curb-65 score 1, for home treatment and have every line marked: drug choice, dose, route, frequency and duration, checked against the patient's allergies, current medicines, renal function and the interaction database, with each error explained.
medium19 scoring rules
- Patient
- 72 years, male, 82 kg
- Diagnosis
- Community-acquired pneumonia, CURB-65 score 1, for home treatment
- Renal function
- eGFR 62 mL/min/1.73m²
- Allergies
- Penicillin
- Current medicines
- warfarin 4 mg once daily, mechanical mitral valve, target INR 2.5 to 3.5; atorvastatin 20 mg at night
The scenario
Patient B-311, a 72-year-old man, comes to the clinic with three days of productive cough, fever to 38.6 °C and right-sided pleuritic chest pain. He is alert and orientated, respiratory rate 22, blood pressure 128/76, oxygen saturation 95% on air. Bronchial breathing at the right base. Chest radiograph shows right lower lobe consolidation. CURB-65 score 1: he can be treated at home.
He has a mechanical mitral valve and takes warfarin, INR today 3.1 (target 2.5 to 3.5), and atorvastatin for hypercholesterolaemia. In 2015 amoxicillin caused widespread urticaria within an hour of the first dose. Creatinine 1.1 mg/dL, eGFR 62. Liver function normal. Weight 82 kg.
Your task
Prescribe an oral antibiotic for the pneumonia and something for the fever and pleuritic pain. His warfarin and atorvastatin continue. Write the instructions and monitoring you would give him.
What gets marked
- Whether you chose an indicated drug, and whether you avoided the contraindicated ones.
- Dose, route, frequency and duration against the range for this patient.
- Renal and hepatic dose adjustment where this patient's numbers demand it.
- Allergy cross-reactivity and interactions with the medicines already on the chart.
- The instructions and monitoring you write, not only the drug you pick.
19 scoring rules apply to this scenario. A single critical error fails the attempt whatever the score.
Log in to prescribe for "Community-acquired pneumonia in a penicillin-allergic patient taking warfarin"
A free account opens the prescription pad: search the formulary, write the chart, and have it marked line by line by the safety engine.
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.