Choices A. Azithromycin is sometimes used for the outpatient treatment of CAP (although there is >25% resistance ). However, diagnosis with chest x-ray is required prior to treatment.
Choice B.Сeftriaxone plus azithromycin may be used for hospitalized patients (not in intensive care). However, diagnosis with chest x-ray is required prior to treatment.
Explanation
Educational objective: The diagnosis of community-acquired pneumonia requires the presence of a lobar, interstitial, or cavitary infiltrate on chest imaging (eg, chest x-ray). Sputum and blood cultures are typically not required in the outpatient setting as empiric oral antibiotics are almost always curative.
Choice D. Mycoplasma pneumonia is the most common cause of atypical pneumonia (indolent fever, malaise, and cough) and frequently results in the formation of cold agglutinins (not routinely used for diagnosis). However, M pneumonia is less likely to cause focal findings on lung examination, can be accompanied by extrapulmonary (eg, gastrointestinal) manifestations, and usually causes indolent rather than acute symptoms.
Choice E. Influenza tends to cause the abrupt onset of systemic (eg, fever, malaise, myalgias) and upper respiratory (eg, rhinorrhea, sore throat) symptoms. This patient has no upper respiratory symptoms.
Choice F. Sputum and blood cultures are typically not required in the outpatient setting as empiric oral antibiotics (eg, azithromycin, levofloxacin) are usually curative. An infiltrate on chest x-ray confirms CAP.
Choice G. Symptomatic treatment alone in the setting of consolidation is insufficient due to the risk of the secondary bacterial pneumonia
