American Board of Internal Medicine (ABIM) Certification Practice Exam

Which treatment option is recommended for a community-acquired pneumonia (CAP) outpatient who is previously healthy?

1. Respiratory fluoroquinolone

2. Macrolide or doxycycline

3. β-lactam plus a macrolide

4. Doxycycline plus glucocorticoid

The correct answer is: Macrolide or doxycycline

For an outpatient with community-acquired pneumonia (CAP) who is previously healthy, the recommended treatment option is a macrolide or doxycycline. This recommendation is based on specific guidelines for the management of CAP in otherwise healthy adults. Macrolides, such as azithromycin or clarithromycin, and doxycycline are effective against the most common pathogens associated with CAP, which include Streptococcus pneumoniae and atypical bacteria like Mycoplasma pneumoniae and Chlamydophila pneumoniae. These treatment options are preferred because they provide good coverage for the typical and atypical organisms likely responsible for the infection in a previously healthy individual who does not have significant comorbidities or risk factors for drug-resistant organisms. Considering the other options: - Respiratory fluoroquinolones are generally reserved for patients who have more complicated presentations or those with coexisting health issues, as they cover a broader range of organisms but are not the first-line treatments for healthy outpatient cases. - A β-lactam plus a macrolide is typically recommended for patients with significant comorbidities or those requiring hospitalization, not for those without prior health issues. - The combination of doxycycline plus glucocorticoid is not a standard treatment for