NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

Which antibiotic combination is preferred for high-risk CAP patients with comorbidities?

1. Beta-lactam + macrolide or doxycycline

2. Respiratory fluoroquinolone monotherapy

3. Amoxicillin/clavulanate

4. Ceftriaxone or cefotaxime + vancomycin

The correct answer is: Beta-lactam + macrolide or doxycycline

In high-risk community-acquired pneumonia (CAP) patients with comorbidities, such as chronic heart, lung, liver, or renal disease, a beta-lactam antibiotic in combination with a macrolide or doxycycline is the preferred antibiotic regimen. This combination provides broad coverage against the typical pathogens that cause pneumonia, including Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms like Mycoplasma pneumoniae and Chlamydophila pneumoniae. Option B, respiratory fluoroquinolone monotherapy, may be considered in cases where the patient has a penicillin allergy or if local resistance patterns warrant its use but is not the preferred regimen for high-risk patients with comorbidities. Option C, amoxicillin/clavulanate, is not the preferred choice for high-risk CAP patients with comorbidities due to its narrower spectrum of activity compared to a beta-lactam/macrolide or doxycycline regimen. Option D, ceftriaxone or cefotaxime plus vancomycin, may be considered in cases of suspected MRSA or Pseudomonas aeruginosa infection but is not routinely recommended as the first-line therapy for high-risk CAP patients with comorbidities.