Case of pneumococcal (PRSP) bronchitis: Gram staining as the earliest and useful indicator for evaluating the effectiveness of antimicrobial therapy in outpatient.

A 75-year-old man was seen in the general practice our hospital because of fever 38-39℃, cough and purulent sputa on January 8 th . Six days before visit, he had chief complaint. The day before, visited a clinic. chest X-ray showed no pneumonia shadow suggesting bronchitis with old tuberculous changes. Azithromycin administered, but improvement seen. doctor sent him to hospital. Gram-stained sputum samples gram- positive diplococcus, later identified as Streptococcus pneumoniae (PRSP). He administered two grams ampicillin for 30 minutes. smaller or gram-negative pneumococci at completion administration agent, decreased number extracellular cocci increased phagocyted small weekly stained hours after administration. We estimated effectiveness prescribe 2g amoxicillin hydrate (AMPC) (500mgX4) 2days followed by 1.5g AMPC (500mgX3) next 5days (till 2/15). 7 (2/14) again fever, amount sputa. culture first (2/8) revealed (PRSP) 3+ resistant penicillin ampicillin. But little we confirmed prescribing additional antimicrobial agent. 12 (2/19) follow up course, getting better having watery Streptococcus. However, some pneumococci, predicted coming relapse bronchitis. prescribed new ketolide drug telithromycin (TEL,300mgX 2) 3days. On 15 (2/22) respiratory symptom suggestive pneumococcus. recovered from present here case which morphological changes and/or S. observed obtained agents presented useful information reliable therapeutic indicator check could prevent worsening outpatient.