COPD - acute infective exacerbation (Antimicrobial)

Warning

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)

5 to 7 days

Last reviewed: 25/08/2022

Next review date: 25/08/2025

Author(s): Antimicrobial Management Team.

Version: 2

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Alison Macdonald, Area Antimicrobial Pharmacist.

Document Id: AMT158