Infective exacerbation of COPD

Amoxicillin oral 1g 8 hourly

or

Doxycycline oral 200mg stat, then 100mg once daily

N.B. In pregnant patients, doxycycline is contraindicated. See here for an alternative option in penicillin allergic pregnant patients.

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.