A 28-year-old woman presents with 3 days of fever, rusty sputum, and right-sided pleuritic chest pain. Chest X-ray shows consolidation in the right lower lobe. Sputum Gram stain shows lancet-shaped gram-positive diplococci. Blood cultures are pending. Which is the most appropriate empiric antibiotic regimen for outpatient management?

• A Ceftriaxone 1 g IV daily
• B Azithromycin 500 mg day 1, then 250 mg daily
• C Levofloxacin 750 mg daily
• D Amoxicillin 500 mg three times daily ✓

Explanation

This is classic pneumococcal pneumonia (rusty sputum, lancet-shaped gram-positive diplococci, lobar consolidation). For outpatient management of community-acquired pneumonia in previously healthy adults without comorbidities, IDSA/ATS guidelines recommend amoxicillin (high-dose) as first-line for suspected pneumococcal pneumonia. Macrolides are alternatives but resistance is increasing. Respiratory fluoroquinolones are reserved for those with comorbidities or penicillin allergy.

Reference: IDSA/ATS Guidelines for CAP, 2019 ed.

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Written and medically reviewed by the StethoPrep medical team.