34 year old woman with fever and right lower lobe consolidation

A 34-year-old woman who is healthy without underlying medical problems presents to clinic with complaints of temperature up to 101°F and cough with greenish sputum production for 2 days without any dyspnea. Her heart rate is 88/min, and her respiratory rate is 18/min. There is no accessory muscle use or conversational dyspnea, nor are there wheezes, bronchial breath sounds, rales, or egophony over the right lower lung fields. Chest X-ray film reveals a right lower lobe consolidation. A CBC shows a leukocyte count of 13,000/mm3. Which of the following is the most appropriate pharmacotherapy?

  1. Amoxicillin
  2. Ampicillin-sulbactam
  3. Ceftriaxone
  4. Erythromycin
  5. Erythromycin plus ceftriaxone

The correct answer is 4. Erythromycin.

The first step in the approach to this patient with a community-acquired pneumonia is to categorize her condition according to the American Thoracic Society guidelines (1993), which are based on severity of illness, age, comorbidities, and the need for hospitalization. This patient does not meet the criteria for hospitalization (one of the following is needed: respiratory rate > 30 breaths/min, room air PaO2< 60 mm Hg, O2 saturation less than 90% on room air, or bilateral or multiple lobes involved), and she is younger than 60 years without any comorbidities. The most common organisms are Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Haemophilus influenzae, Legionella, and respiratory viruses. Recommended treatment is with erythromycin or a related macrolide, such as azithromycin or clarithromycin.

Amoxicillin (choice 1) does not have broad enough coverage to include the organisms listed above.

Ceftriaxone (choice 3) and ampicillin-sulbactam (choice 2) are used for hospitalized patients with community-acquired pneumonia.

Erythromycin plus ceftriaxone (choice 5) is reserved for patients who are severely ill and hospitalized.

Meet the Author

Dr. Lawrence Kindo

I am a medical blogger who loves to share interesting health stuff. This blog is dedicated to dissemination of medical MCQs. Enjoy!

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  • Vijaykumar s

    Good information

  • Anirudha

    The green colour of sputum suggest of pseudomonas infection. Which is mostly hospital acquired