Hypersensitivity

Patient comes in for a recheck. She was last seen by Dr. on March 17, 2016. At that time, she was given treatment of antibiotic for Augmentin for 7 to 10 days because of an acute infection. Today, she states that she currently still feels ill. She is still coughing up yellow mucus that taste gross she says and cannot sleep due to coughing. She finished the Augmentin about one week ago. She feels if she coughs all her ribs hurt and her head hurts. She has been using an Aerospan inhaler as well two puffs twice daily and that has helped with the cough, and while she was on antibiotics she did have resolution of her cough as well. It just seemed to have recurred after she stopped the antibiotic use. She has been using her ProAir about three times per day and that also helps resolve some of her troubles, however, she continues to require this. She is also using QNASL nasal spray one spray each nostril twice daily as well. She feels that the Augmentin was really helping. She felt much better and seem like it almost cleared all the way, but then her symptoms recurred. She continues to get her allergy immunotherapy with us as well. Her peak flows today are at 250 and her past best was at 310.

ASSESSMENT:
1. Acute bronchitis.
2. Infectious-induced asthma.
3. Allergic rhinosinusitis.
4. Allergic conjunctivitis.
5. Hypersensitivity.

PLAN:
1. At this time, I would like to try continuing the Augmentin for a little longer since it did seem to help resolve at first, but now has recurred. We will do Augmentin 875 mg one tab twice daily for 14 days. If she does not have any resolution in the next few days, I did encourage her to call us so we can switch antibiotics since she has been on a dose of this prior.
2. She also cannot tolerate the Aerospan taste. She states it is really yucky and would prefer not use that one again, but needs something else during this time of infection. I did provide her an Asmanex 200 mcg to use two puffs twice daily to help with her lung function. We were out of QVAR samples at that time and she is to tell me how the Asmanex is going. If she does not feel that it is helping much like the Aerospan then we may want to switch to QVAR.
3. She will continue using her ProAir as needed and QNASL twice daily.
4. We will follow up in two weeks with Mary to ensure that she gets through with this infection and no longer has any trouble.

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