Infective Exacerbation of COPD

Antimicrobial prescribing: NHS Forth Valley
NHS Forth Valley

First Line

Therapy

Amoxicillin 500mg PO 8 hourly

or

Doxycyline 200mg PO STAT, then 100mg daily

or

Clarithromycin 500mg PO 12 hourly

Notes:

Second Line

Therapy

Co-trimoxazole 960mg PO 12 hourly

(see BNF for dosing advice of co-trimoxazole in patients with renal impairment [<30 ml/min])

 

If oral route compromised: Ceftriaxone 2g IV 24 hourly (administered as per local SOP)

Notes:

Notes

Treat with antibiotics if 2 of the following are present

  • purulent sputum
  • increased SOB
  • increased sputum volume

Pyrexia and tachycardia also indicative of infection

Send sputum for culture if possible and appropriate. Culture most useful where there has been poor clinical response to an empirical antibiotic previously or where antibiotic options are limited e.g. allergy, drug interaction.

Treatment duration: 5 days.  Severe infection may require longer (e.g 7-10 days) guided by clinical response.