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Severe CAP — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesSevere CAPRACP Adult Medicine

A 72-year-old man with high-severity CAP (CURB-65 score 4) is admitted to ICU requiring mechanical ventilation. He has no penicillin allergy. Legionella urinary antigen is pending. What is the most appropriate empirical antibiotic regimen?

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Correct answer: E — Ceftriaxone IV plus azithromycin IV

High-severity CAP requiring ICU admission warrants ceftriaxone 2 g IV daily (broader gram-negative cover) plus azithromycin IV (atypical coverage including Legionella). Per the 2025 eTG update, IV hydrocortisone should also be considered within 24 hours for critically unwell patients requiring high-flow oxygen or ventilation.

Reference: eTG Antibiotic – 2025 – Community-Acquired Pneumonia in Adults