16.陳先生罹患COPD（Group C）與DM，最近2個月內發生過community acquired penumonia。這幾天其因 dyspnea、purulent sputum、痰液增多等症狀而就醫。下列empirical antibiotics何者不適當？
(A)sulfamethoxazole and trimethoprim
(B)amoxicillin and clavulanate
(C)cefuroxime
(D)levofloxacin

把HAP也整理進來如下，有錯再提醒一下

Pseudomonas aeruginosa is resistant to both sulfonamides and TMP. Although high doses of TMP-SMZ may have some antibacterial effect on Mycoplasma pneumoniae, Chlamydia pneumoniae, and Chlamydia trachomatis, they are considered to be clinically resistant to TMP-SMZ.

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Ref: https://academic.oup.com/cid/article/32/11/1608/464214

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門診病人：Aminopenicillin+/-Clavulanic acid、Macrolide、Tetracycline(ex.Doxycycline)

有風險因子(嚴重COPD、共併症、頻繁惡化)：ß-lactam+ß-lactamase抑制劑、FQ、第2/3代Cephalosporin

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【原文】

In outpatients with low-risk factors, a low-cost antibiotic regimen is a reasonable option. Empirical treatment with an aminopenicillin with or without clavulanic acid, a macrolide, or tetracycline derivative such a doxycycline may be used. Although other antibiotics are commonly prescribed, no data support superiority in this setting when compared with conventional, less expensive agents. An acute exacerbation of COPD is one of the few instances in which antibiotic therapy is warranted to treat a respiratory infection in the absence of evidence of lower respiratory tract involvement (ie, pneumonia).
Patients with COPD and risk factors for poor outcome (severe COPD, comorbid conditions, history of frequent exacerbations) may be more susceptible to resistant pathogens. As such, guidelines recommend that a broad-spectrum antibiotic regimen be considered, including β-lactam–β-lactamase inhibitor combinations, quinolone antibiotics, or second- or third-generation cephalosporins

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Ref：Applied 12版