Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Antimicrobial prescribing: NHS Borders
NHS Borders

Duration

Duration 5 days then review.

First Line - not severe

Therapy

Amoxicillin oral 500mg 8 hourly

Notes:

Penicillin allergy – not severe

Therapy

Doxycycline oral 200mg on first day then 100mg daily

Notes:

Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) - severe

Therapy

Co-Amoxiclav IV 1.2g 8 hourly

+

Clarithromycin IV 500mg 12 hourly

(Clarithromycin IV should only rarely be necessary in COPD) 

Penicillin allergy – Discuss with Consultant Microbiologist

Notes:

Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) – severe Pseudomonal infections

Therapy

Ciprofloxacin 750mg oral 12 hourly

(use IV route 400mg only if oral not possible)

Notes:

Notes

Patients with two or more of the three cardinal signs may benefit from treatment with antimicrobials

  • Increased shortness of breath
  • Increased sputum volume
  • Purulent sputum

Antimicrobials should be tailored against previous isolates where possible.

Consider sending a throat swab in viral transport medium for respiratory viral studies.

Fluroquinolones

Refer to important safety information for all quinolones prior to prescribing.

See MHRA Drug Safety Update January 2024: Fluoroquinolones must only be used in situations when other antibiotics, that are commonly recommended for the infection, are inappropriate such as:

  • there is resistance to other first-line antibiotics recommended for the infection
  • other first-line antibiotics are contraindicated in an individual patient
  • other first-line antibiotics have caused side effects in the patient requiring treatment to be stopped
  • treatment with other first-line antibiotics has failed