Acute Infective Exacerbation of COPD / Acute Bronchitis

No consolidation on x-ray.

Note: click here for bronchiectasis antibiotic guideline

Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)

A

Minor to moderate infection

Review doses in renal impairment

AMOXICILLIN 500mg po tds

Treatment duration : typically 5 days

Note: Consider longer duration if symptoms do not improve as expected after 3 days

DOXYCYCLINE 200mg po od

Treatment duration : typically 5 days

Note: Consider longer duration if symptoms do not improve as expected after 3 days

B

Moderate to severe infection

Review doses in renal impairment

AMOXICILLIN 1g po tds
Plus
DOXYCYCLINE 200mg po od

OR

If prior treatment with either Amoxicillin or Doxycycline, use:
CO-AMOXICLAV 625mg po tds as monotherapy

Treatment duration: typically 7 days

DOXYCYCLINE 200mg po od

OR
if contraindicated or prior treatment with doxycycline, use:

LEVOFLOXACIN 500mg po bd      (Consider reducing to 500mg od if patient clearly improving)

Treatment duration: typically 7 days

C

Severe life threatening infection

 Review doses in renal impairment

Age less than 65 years:                                

CO-AMOXICLAV 1.2g iv tds

Age greater than 65 years:       

TAZOCIN 4.5g iv tds

All ages: if suspected / confirmed MRSA, ADD:

VANCOMYCIN 1g iv bd

(If CrCl <50, reduce dose as per renal dosing guidance)

Treatment duration: 7 - 10 days

LEVOFLOXACIN 500mg po/iv bd

(Oral route preferred. Consider reducing to 500mg od if patient clearly improving)

Plus

VANCOMYCIN 1g iv bd

(If CrCl <50, reduce dose as per renal dosing guidance)

 Treatment duration: 7 - 10 days

IV to Oral Switch(explanatory notes)

CO-AMOXICLAV 625mg po tds (unless lab results indicate otherwise)

Typically for a total of 7- 10 days therapy

LEVOFLOXACIN 500mg po bd  

(Consider reducing to 500mg od if patient clearly improving)

Typically for a total of 7-10 days therapy

Last reviewed: 27/10/15

For guidance on the administration of intravenous antibiotics
click here (GHNHSFT intranet only)