Early antibiotics for community-acquired pneumonia (CAP) can improve outcomes, but diagnostic uncertainty makes timely intervention difficult. We explored whether early (first 24 hours) use of ceftriaxone and azithromycin identified CAP patients and what downstream antibiotic decisions followed this treatment. We studied 108 inpatients receiving ceftriaxone and azithromycin within 24 hours of admission. We reviewed demographic, clinical and laboratory characteristics, radiography, antibiotic duration, and discharge diagnosis. Mean age was 61. Most had dyspnea and other pneumonia, heart failure, or lung disease symptoms. Only 39% had CAP. Patients with and without pneumonia had similar demographic features and Patient Outcome Research Team scores and often continued antibiotics. Early ceftriaxone and azithromycin is an imperfect surrogate for a CAP diagnosis, but these patients present with cardiorespiratory disease where CAP is in the differential. This is a group of patients worth considering for treatment guidelines because some have CAP even when not noted in the provisional admission diagnosis.