American Board of Internal Medicine (ABIM) Certification Practice Exam

In the case of inpatient CAP treatment for patients in the non-ICU setting, which treatment regimen is recommended?

1. Antipseudomonal β-lactam with aminoglycoside

2. β-lactam plus either macrolide or doxycycline

3. Respiratory fluoroquinolone only

4. High dose IG + LABA

The correct answer is: β-lactam plus either macrolide or doxycycline

In the non-ICU setting for the treatment of inpatient Community-Acquired Pneumonia (CAP), the recommended regimen is a beta-lactam antibiotic combined with either a macrolide or doxycycline. This combination is effective because it covers the predominant pathogens responsible for CAP, particularly Streptococcus pneumoniae, which is the most common cause of this condition, as well as atypical organisms like Mycoplasma pneumoniae and Chlamydophila pneumoniae that often require coverage. Beta-lactams such as ceftriaxone or piperacillin-tazobactam are reliable options for addressing typical bacteria, while macrolides (such as azithromycin) and doxycycline provide coverage for atypical pathogens. This dual approach ensures a broader spectrum of activity, balancing efficacy and resistance patterns commonly seen in pneumonia cases. While the other treatment options may address certain specific situations, they do not provide the broad coverage needed for typical and atypical pathogens found in inpatient settings with CAP. For instance, the use of antipseudomonal β-lactam with aminoglycoside tends to be reserved for patients suspected of having Pseudomonas infection, which is less common in typical CAP cases. Similarly, a respiratory