A 70-year-old nursing home resident presents with confusion, fever, and right lower lobe consolidation. CURB-65 score is 3. He has aspiration risk. What is the most appropriate antibiotic regimen?
- A Azithromycin monotherapy
- B Piperacillin-tazobactam or ampicillin-sulbactam to cover anaerobes plus a respiratory fluoroquinolone ✓
- C Amoxicillin-clavulanate orally
- D Doxycycline plus ceftriaxone
Explanation
Healthcare-associated aspiration pneumonia with a CURB-65 of 3 warrants hospitalisation and broad-spectrum coverage including anaerobes (from oropharyngeal flora). Piperacillin-tazobactam or ampicillin-sulbactam provides anaerobic and Gram-negative coverage. Addition of a respiratory fluoroquinolone (levofloxacin/moxifloxacin) addresses atypical organisms and provides broader Gram-positive coverage. Azithromycin monotherapy is appropriate only for mild community-acquired pneumonia. Doxycycline-ceftriaxone is used for atypical-covered regimens but lacks anaerobic coverage for aspiration.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.