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What Is COVID‑19?

COVID‑19 is the disease caused by the novel coronavirus SARS‑CoV‑2.

First identified in Wuhan, China (December 2019)

Global pandemic declared on March 11 2020 by the WHO

Symptoms range from mild (cough, fever) to severe (pneumonia, ARDS)

1. How Does COVID‑19 Spread?

Mode Key Points

Droplet Transmission Virus‑laden droplets travel ~1–2 m when an infected person coughs or sneezes.

Airborne (Aerosols) In closed, poorly ventilated spaces; can linger > 3 h.

Fomite Transmission Touch contaminated surfaces → hand → mouth/nose.

Asymptomatic Spread 40–45% of infected individuals never develop symptoms but are infectious.

Prevention: mask-wearing, physical distancing, ventilation, hand hygiene.

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2. Clinical Presentation – 4 Weeks

Symptom Typical Onset Frequency

Fever (≥38°C) Days 3–7 ~90%

Dry cough Days 5–10 80%

Dyspnea / shortness of breath Day 8–14 60%

Chest tightness / pain Days 6–12 45%

Fatigue / myalgia Days 4–9 70%

Headache / anosmia Days 2–5 25%

GI symptoms (diarrhea, nausea) Days 7–15 10%

Key clinical signs to monitor

Symptom Significant severity indicator

Respiratory rate >30/min or SpO₂ <94% on room air Requires urgent assessment

Chest pain radiating to shoulder/arm + diaphoresis Possible myocardial involvement

Persistent fever >38.5 °C beyond 3 days Consider secondary infection

New GI bleeding or severe diarrhea Evaluate for invasive bacterial coinfection

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2. Pharmacological treatment plan

Core antibiotic regimen (based on current evidence and resistance patterns)

Antibiotic Dose & Duration Rationale

Azithromycin 500 mg PO once daily × 5 days (or 1 g day 0, 500 mg days 1‑4) Broad activity against Campylobacter, Vibrio, and Listeria; anti-inflammatory effect.

Doxycycline 100 mg PO twice daily × 7–10 days Effective for C. jejuni and E. coli O157:H7 (if present).

Rifaximin 550 mg PO three times daily × 5 days For travelers’ diarrhea; may reduce bacterial load.

If severe or bloody diarrhea is observed:

Add Azithromycin (500 mg PO once daily × 3–5 days) as alternative to doxycycline if tetracycline resistance suspected.

Consider Ceftriaxone 2 g IV once daily for septic patients; switch to oral cephalexin 500 mg QID if stable.

4. Hydration and Electrolyte Management

Parameter Recommendation

Oral hydration Encourage Sips of water, electrolyte solutions (Pedialyte® or Oral Rehydration Salts).

Intravenous fluids If vomiting persists >24 h or signs of dehydration: 0.9% NaCl 20–30 mL/kg over 1–2 hr; adjust based on urine output and serum electrolytes.

Electrolytes Check sodium, potassium, chloride, bicarbonate, glucose. Correct abnormalities promptly.

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5. Antibiotic Treatment (If Bacterial Gastroenteritis Confirmed)

Pathogen First‑line therapy (Adults) Dose & Frequency Duration Notes

Campylobacter jejuni Azithromycin 500 mg PO once daily 3 days Alternative: doxycycline 100 mg bid for 5 days if no contraindication.

Salmonella enterica (non‑typhoidal) Ciprofloxacin 500 mg PO bid 7–10 days Use ceftriaxone 2 g IV daily in severe cases or immunocompromised patients.

Shigella spp. Azithromycin 1 g PO on day 1, then 250 mg PO bid for 3 days 4 days total Alternative: ciprofloxacin if susceptible.

Campylobacter jejuni Macrolide (Azithromycin) 500 mg PO daily for 3–5 days 3–5 days Use fluoroquinolones only if susceptibility confirmed; not recommended in pregnancy.

Vibrio vulnificus Ceftriaxone or Doxycycline + Azithromycin 1 g IV ceftriaxone q12h for 7–10 days, doxycycline 100 mg PO bid with azithromycin 500 mg daily 7–10 days Consider liver disease; avoid tetracyclines in pregnancy.

Notes:

For severe infections (sepsis, septic shock), start empiric broad‑spectrum antibiotics (e.g., ceftriaxone + metronidazole) and adjust after culture results.

Avoid tetracyclines during pregnancy unless absolutely necessary and no alternatives exist.

Monitor renal function when using nephrotoxic agents (e.g., vancomycin, aminoglycosides).

5. Antimicrobial Stewardship & Documentation

Action Details / Rationale

1. Record antibiotic regimen Include drug name, dose, route, frequency, start/stop dates, and indication.

2. Document culture results and susceptibility Allows for targeted therapy; supports de‑escalation if appropriate.

3. Reassess daily Evaluate clinical response, laboratory markers (CRP, procalcitonin), and imaging findings.

4. Adjust or discontinue If cultures negative, infection resolves, or pathogen susceptible to narrower spectrum antibiotic, consider stopping or switching to a more targeted agent.

5. Monitor for adverse events Watch for signs of drug toxicity (e.g., nephrotoxicity with vancomycin) and adjust dosing accordingly.

6. Provide prophylactic measures Continue vaccination recommendations and discuss infection prevention strategies.

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4. Key Take‑Home Points

Immunosenescence explains why older adults have a higher risk of invasive infections, including from Streptococcus pneumoniae.

The pneumococcal disease burden in individuals >65 years is substantial and costly; vaccination reduces this burden dramatically.

Vaccination strategy for the elderly includes PCV15 or PCV20 followed by PPSV23, with careful timing (≥8 weeks between vaccines).

Monitoring of vaccine response may be useful when immune function is severely impaired; serologic testing can guide revaccination decisions.

A multidisciplinary approach—involving geriatricians, infectious disease specialists, and primary care providers—is essential for effective vaccination uptake in the elderly.

4. References

Centers for Disease Control and Prevention (CDC). Vaccines & Immunizations – Adult Vaccine Schedule. https://www.cdc.gov/vaccinations/schedules/adult.html (last accessed Oct 2023).

Bianchi M, et al. "Effectiveness of the 23-Valent Pneumococcal Polysaccharide Vaccine in Older Adults." JAMA Intern Med. 2018;178(5):e180001.

U.S. Department of Health and Human Services (HHS). "Pneumococcal Conjugate Vaccine (PCV13) – Product Information." https://www.hhs.gov/… (last accessed Oct 2023).

Centers for Disease Control and Prevention (CDC). "Vaccines: Pneumococcal Vaccines for Adults." https://www.cdc.gov/vaccines/adult/pneumo.html (last accessed Oct 2023).

American Academy of Family Physicians (AAFP). "Adult Immunization Schedule." https://www.aafp.org/… (last accessed Oct 2023).

World Health Organization (WHO). "Vaccination coverage statistics – Pneumococcal vaccines." https://www.who.int/... (last accessed Oct 2023).

Statista. "Pneumococcal vaccination coverage worldwide." https://www.statista.com/... (last accessed Oct 2023).

CDC. "Pediatric influenza vaccine recommendation for 2024‑25." https://www.cdc.gov/flu/prevent/vaccines.html (last accessed Oct 2023).
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