COPD - acute infective exacerbation
Amoxicillin 1g three times daily
OR Doxycycline 200mg stat then 100mg once daily
OR Clarithromycin 500mg twice daily
If resistance likely (co-morbid disease, severe COPD, frequent exacerbations, antibiotics in last 3 months), if no clinical improvement or if severe exacerbation
oral 625mg three times daily PLUS amoxicillin 500mg three times daily
OR IV 1·2g every 8 hours
In penicillin allergy
Doxycycline 200mg stat then 100mg once daily
For hospital inpatients with penicillin allergy
Levofloxacin 500mg twice daily (oral or IV) (see BNF warnings and MHRA Drug Safety Alert)
5 to 7 days
Treat exacerbations promptly with antibiotics if purulent sputum and increased shortness of breath and/or increased sputum volume. In patients with recurrent infections, previous sputum results may be useful to guide antimicrobial choice.
Consider treatment in patients with co-morbidity, aged over 75 years, pyrexia, heart failure, diabetes or stroke. Risk factors for antibiotic resistant organisms include co-morbid disease, severe COPD, frequent exacerbations, antibiotics in last 3 months.
Note: Tetracycline resistance is low in Haemophilus influenzae, a common respiratory pathogen in COPD exacerbations.
See also Managing COPD - Education and Self Management for use of Rescue Medication.
Intravenous therapy only required if nil by mouth.
For glossary of terms see Glossary