Infective exacerbation of COPD

Duration

3-5 days

First Line

Therapy

Amoxicillin 1g PO every 8 hours

Or Clarithromycin 500mg PO every 12 hours

Or Doxycycline 200mg PO on day 1 then 100mg daily

Notes:

In pregnant patients, doxycycline is contraindicated. 

Clarithromycin should not be prescribed concurrently with ciclosporin, sirolimus and tacrolimus.

Notes

In patients with COPD, antibiotic treatment is indicated if the patient reports increased sputum purulence AND at least one other of:

  • increased breathlessness
  • increase in sputum volume

In primary care, consider hospitalisation if features of a severe exacerbation are present, such as

  • marked dyspnoea, tachypnoea, hypoxia (<90% on room air), pursed-lip breathing, use of accessory muscles at rest,
  • acute confusion,
  • new-onset cyanosis,
  • peripheral oedema,
  • or marked reduction in ability to manage usual activities of daily living.

Sputum samples for culture are not routinely recommended.

Do not use CURB65/CRB65 for severity assessment in the absence of consolidation on a chest radiograph; this score is only validated for use in community-acquired pneumonia. 

Streptococcus pneumoniae in the respiratory tract responds to penicillin or amoxicillin, even if intermediate susceptibility to penicillin is found on testing. It is the most common cause of lower respiratory tract infections in the community.

Doxycycline resistance rates in Haemophilus influenzae are low.