COPD - acute infective exacerbation (Antimicrobial)
TAM (Treatments and Medicines) NHS Highland
What's new / Latest updates
Please note the change of durations.
NICE guideline (NG115) Chronic obstructive pulmonary disease in over 16s: diagnosis and management
GOLD
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.
Drug details
Amoxicillin 1g three times daily
5 days
OR Doxycycline 200mg stat then 100mg once daily
5 days
OR Clarithromycin 500mg twice daily
5 Days
If resistance likely (co-morbid disease, severe COPD, frequent exacerbations, antibiotics in last 3 months), if no clinical improvement or if severe exacerbation
Co-amoxiclav oral 625mg three times daily PLUS amoxicillin 500mg three times daily OR IV 1·2g every 8 hours
5 Days
In penicillin allergy
Doxycycline 200mg stat then 100mg once daily
5 Days
For hospital inpatients with penicillin allergy
Levofloxacin 500mg twice daily (oral or IV) (see BNF warnings and MHRA Drug Safety Alert (updated 22 January 2024))
5 to 7 days