Pneumonia USMLE Step 1 Practice Question
A 55-year-old man with COPD presents to the emergency department with a 5-day history of fever (38.9°C), productive cough with purulent sputum, dyspnea, and right-sided pleuritic chest pain. He has been hospitalized 3 times in the past 2 years for pneumonia and received multiple courses of fluoroquinolones. Physical examination reveals decreased breath sounds and crackles at the right lung base. Chest X-ray shows a right lower lobe infiltrate. Sputum culture grows a gram-negative rod that is resistant to levofloxacin and ciprofloxacin. Which of the following is the most appropriate empiric antibiotic regimen for this patient?
Answer choices
- ALevofloxacin 750 mg IV daily
- BCeftriaxone 1 g IV every 12 hours plus doxycycline 100 mg IV every 12 hours
- CPiperacillin-tazobactam 4.5 g IV every 6 hoursCorrect answer
- DAzithromycin 500 mg IV daily plus amoxicillin-clavulanate 875 mg PO three times daily
- ECefpodoxime 200 mg PO every 12 hours plus metronidazole 500 mg IV every 8 hours
- FAmpicillin 2 g IV every 4 hours plus gentamicin 5 mg/kg IV daily
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