Empiric therapy for mild-to-moderate nosocomial pneumonia may include which antibiotic class?

• A. Macrolide.
• B. Second-generation cephalosporin.
• C. Fluoroquinolone.
• D. Aminoglycoside.

Answer: (B)

In nosocomial pneumonia that’s mild to moderate, the goal is to cover the organisms commonly acquired in the hospital without overdoing the spectrum. A second-generation cephalosporin fits this need because it expands coverage beyond the first-generation agents to include more Gram-negative bacteria such as Haemophilus influenzae and many Enterobacterales, which are frequent in hospital-acquired infections. It provides reliable, well-tolerated beta-lactam activity and good safety compared with other options like aminoglycosides, which have limited lung penetration and higher toxicity risk, or fluoroquinolones, which bring concerns about resistance and adverse effects. Macrolides alone don’t offer adequate Gram-negative coverage for hospital pathogens, making them less suitable as monotherapy in this setting. This approach is most appropriate when there isn’t strong risk for Pseudomonas or MRSA, allowing effective empiric treatment without unnecessarily broad coverage.