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Community-acquired pneumonia — MRCEM SBA MCQ

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EasyRespiratory emergenciesCommunity-acquired pneumoniaMRCEM SBA

A 49-year-old woman presents to the emergency department with fever, productive cough and pleuritic pain. Chest radiography shows right lower-lobe consolidation. She is alert, her respiratory rate is 31/min, blood pressure 126/74 mmHg and SpO₂ 96% on air. Her serum urea is 8.4 mmol/L. She has no significant comorbidity, can take oral medicines and has no drug allergies. There are no clinical or epidemiological features suggesting an atypical pathogen. She would prefer ambulatory care, and a same-day emergency care (SDEC) service can provide ongoing assessment. What is the most appropriate initial antibiotic and place-of-care plan?

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

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Correct answer: E — Start oral amoxicillin and continue care in SDEC.

In hospital, community-acquired pneumonia is assessed using clinical judgement alongside CURB65. This patient scores **2**: one point for respiratory rate ≥30/min and one for urea >7 mmol/L. Her age, mental state and blood pressure add no points. A score of 2 usually indicates moderate-severity disease; NICE lists SDEC among the possible places of care. Given her stable oxygenation, ability to take oral treatment, preference for ambulatory care and access to ongoing SDEC assessment, oral amoxicillin with continued SDEC care is the best plan. Antibiotics should be started promptly once pneumonia is diagnosed. ([nice.org.uk](https://www.nice.org.uk/guidance/NG250/chapter/recommendations)) **A** mistakes preserved oxygen saturation for sufficient reassurance to discharge without the monitored pathway appropriate to her overall risk. **B** has a suitable care setting, but NICE adds clarithromycin to amoxicillin for moderate-severity disease when an atypical pathogen is suspected; none is suggested here. **C** uses a high-severity regimen and intravenous treatment despite her moderate-severity assessment and ability to take oral medicines. **D** is a reasonable moderate-severity oral alternative when there is penicillin allergy, which she does not have. A CURB65 score informs rather than dictates disposition: inpatient care could also be considered if her clinical circumstances warranted it. ([nice.org.uk](https://www.nice.org.uk/guidance/NG250/chapter/recommendations))

Reference: NICE NG250: Pneumonia: diagnosis and management — recommendations (2 September 2025) — https://www.nice.org.uk/guidance/NG250/chapter/recommendations NICE NG250: Pneumonia: diagnosis and management — antibiotic recommendations and table 1 (2 September 2025) — https://www.nice.org.uk/guidance/NG250/chapter/recommendations NICE NG250 visual summary: Community-acquired pneumonia (adults presenting to hospital) (February 2026) — https://www.nice.org.uk/guidance/ng250/resources/visual-summary-community-acquired-pneumonia-adults-presenting-to-hospital-pdf-15434376301