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Severe community-acquired pneumonia — SCE Acute Medicine MCQ

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ModerateAcute Respiratory PresentationsSevere community-acquired pneumoniaSCE Acute Medicine

A 76-year-old woman is admitted from a nursing home with fever, cough and confusion. RR is 32, BP 92/58 mmHg, urea 12.4 mmol/L, and chest radiograph shows right lower-zone consolidation. Her CURB-65 score is 4. She is penicillin-allergic with previous anaphylaxis. What is the most appropriate next step in management?

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Correct answer: D — Start senior-led treatment for severe community-acquired pneumonia with non-beta-lactam cover

Her CURB-65 score, hypotension, tachypnoea and confusion indicate severe community-acquired pneumonia requiring urgent inpatient antibiotics and senior review. Amoxicillin is inappropriate both for severity and because of true anaphylactic penicillin allergy. Waiting for sputum culture delays time-critical treatment. The key clinical lesson is that severity assessment directs place of care and route of therapy, not just antibiotic choice.

Reference: NICE NG138, BTS community-acquired pneumonia guideline, BNF