A 55-year-old woman with a history of rheumatoid arthritis treated with methotrexate and adalimumab presents with fever, productive cough with yellow sputum, and pleuritic chest pain. Physical exam reveals crackles and egophony over the left lower lobe. A chest X-ray shows consolidation in the left lower lobe. Sputum Gram stain reveals Gram-positive cocci in chains. Which of the following is the most appropriate initial empiric antibiotic therapy?
✓ Correct Answer: Option C
This patient has community-acquired pneumonia (CAP) with risk factors (immunosuppression due to RA treatment) for more severe disease. The recommended empiric outpatient treatment for CAP in patients with comorbidities is a respiratory fluoroquinolone OR a beta-lactam (e.g., ceftriaxone) plus a macrolide (e.g., azithromycin).