Antibiotics for COPD patients (treatment duration 5 to 7 days)
Although the benefit of antibiotics is controversial, it is generally agreed that antibiotics
should be given if there is an increase in two or three symptoms such as colour and volume
of sputum, increasing shortness of breath (Athonisen’s triad), fever, or evidence of
pneumonia on chest x-ray, unless a sputum culture shows a predominant pathogen. More
often, antibiotic choice is empirical.
Antibiotic choice will also depend on whether or not the COPD patient has co-existing
pneumonia (with clinical signs, e.g. bronchial breathing and crackles with increased vocal
resonance, or radiological consolidation).
If a sputum sample shows a specific pathogen, treat according to drug sensitivity results.
Severity
Mild to moderate
COPD
Severe COPD requiring
admission to hospital
Coexisting COPD
and Community
Acquired
Pneumonia (CAP)
First Choice
Doxycycline 200mg on day one,
then 100mg OD (first line)
Or
Amoxicillin/ Clavulanic Acid
625mg PO 8 hourly (second line)
Or
Azithromycin 500mg on day one,
then 250mg for 4 days (third line)
Amoxicillin/ Clavulanic Acid
1.2g IV 8 hourly
Mild CAP:
Doxycycline 200mg on day one,
then 100mg OD (first line)
Or
Azithromycin 500mg on day one,
then 250mg for 4 days.
Moderate CAP: Amoxicillin/
Clavulanic Acid 625mg PO 8 hourly
(second line)
And
Azithromycin 500mg on day one,
then 250mg for 4 days.
Antibiotic allergy

If severe Penicillin allergy use
Doxycycline or Azithromycin

If mild Penicillin allergy use
Cefuroxime 1.5g IV 8 hourly
If severe Penicillin allergy or
any Cephalosporin allergy
contact consultant physician.

If Penicillin allergy, use
Azithromycin alone
(1) Mild Penicillin allergy – rash, nausea etc.
(2) Severe Penicillin allergy - anaphylaxis, angioedema, urticaria, hypotension or
bronchospasm.
Antibiotics for COPD Patients
Finalised 04.09.2015