skip to main content

Community-Acquired Pneumonia — UKMLA MCQ

Instant feedback + full explanation. One question, done properly.

ModerateInfectious DiseasesCommunity-Acquired PneumoniaUKMLAMRCGP AKTPARAMRCEM SBAMRCP Part 1PSA

A 67-year-old man is diagnosed with community-acquired pneumonia. His respiratory rate is 32 breaths/min, blood pressure is 128/74 mmHg and he is not confused, giving a CRB65 score of 2. He can take oral medication, has no penicillin allergy and there is no clinical or epidemiological suspicion of an atypical pathogen. Hospital assessment is being arranged. Which initial oral antibiotic regimen is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Amoxicillin alone

The correct answer is amoxicillin alone. A CRB65 score of 2 usually indicates moderate-severity community-acquired pneumonia, but moderate severity does not itself mandate routine dual therapy. NICE recommends oral amoxicillin first-line when oral treatment is suitable, adding clarithromycin only if an atypical pathogen is suspected. Doxycycline or clarithromycin monotherapy are alternatives when there is penicillin allergy. Co-amoxiclav with a macrolide is used for high-severity disease; co-amoxiclav alone is therefore not the recommended regimen here. Levofloxacin is reserved principally for high-severity disease with penicillin allergy when appropriate, given important fluoroquinolone safety restrictions.

Reference: NICE. Pneumonia: diagnosis and management (NG250), recommendations 1.6.1–1.6.3 and Table 1: antibiotics for community-acquired pneumonia in adults. Published 2025; updated January 2026. https://www.nice.org.uk/guidance/NG250/chapter/recommendations