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Community-acquired pneumonia — SCE Acute Medicine MCQ

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HardAcute Respiratory PresentationsCommunity-acquired pneumoniaSCE Acute Medicine

A 69-year-old man has radiographic community-acquired pneumonia, new confusion, urea 11 mmol/L, respiratory rate 34/min and blood pressure 88/54 mmHg. He had immediate anaphylaxis to amoxicillin and has no previous fluoroquinolone adverse effect. Under current NICE guidance, which empirical regimen is the appropriate high-severity penicillin-allergy option while cultures are obtained?

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

Reveal the answer and explanation

Correct answer: A — Levofloxacin 500 mg orally or intravenously twice daily for 5 days

Explanation lettering: B = shown as A · E = shown as B · D = shown as C · A = shown as D · C = shown as E

B is correct. His CURB65 is at least 4, so this is high-severity CAP. NICE lists levofloxacin 500 mg twice daily for 5 days as the alternative in penicillin allergy, with microbiology advice if a fluoroquinolone is unsuitable. Doxycycline or clarithromycin monotherapy are alternatives for lower-severity disease. Cefalexin is not the listed high-severity anaphylaxis regimen, while co-amoxiclav directly conflicts with the immediate penicillin allergy.

Reference: NICE NG250 pneumonia recommendations: https://www.nice.org.uk/guidance/ng250/chapter/Recommendations