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Severe community-acquired pneumonia — SCE Acute Medicine MCQ

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EasyRespiratory medicineSevere community-acquired pneumoniaSCE Acute Medicine

An 82-year-old man is admitted from a care home with fever, confusion and cough. Respiratory rate is 32/min, blood pressure 88/54 mmHg, urea is 12.4 mmol/L and oxygen saturation is 89% on air. Chest radiograph shows right lower-zone consolidation. He has chronic kidney disease and a new oxygen requirement. What is the most appropriate next step in management?

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Correct answer: B — Admit and start prompt intravenous antibiotics with oxygen and fluid assessment

He has severe community-acquired pneumonia with high-risk features, including hypotension, tachypnoea, raised urea and confusion, requiring hospital care and prompt empirical antibiotics. CT should not delay initial treatment when the diagnosis is supported clinically and radiographically. Early oxygen, fluid assessment and escalation planning are part of acute management in frail older patients.

Reference: NICE NG138 pneumonia antimicrobial prescribing; BTS CAP guideline