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Infective Exacerbation of COPD

Pathogens

Drug Treatment

In This Section

Empiric

Pathogens Known

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Empiric

amoxicillin

HMLSchedNZFPMLnoids

PO 500 mg three times a day

OR, if unable to swallow:

amoxicillin

HMLSchedNZFPMLnoids

IV 1 g every eight hours (early switch to oral amoxicillin)

Penicillin allergy

doxycycline

HMLSchedNZFPML

PO 200 mg on day 1

then PO 100 mg once a day

OR, if unable to swallow (mild penicillin allergy only):

cefuroxime

HMLSchedNZFPMLnoids

IV 1.5 g every eight hours (early switch to oral doxycycline)

Non-response to amoxicillin:

amoxicillin+clavulanic acid

HMLSchedNZFPMLnoids

PO 500 mg/125 mg three times a day

OR, if unable to swallow:

amoxicillin+clavulanic acid

HMLSchedNZFPMLnoids

IV 1 g/200 mg every eight hours (early switch to oral amoxicillin+clavulanic acid)

Severe penicillin allergy

Consult Infectious Diseases/Clinical Microbiology/Respiratory Medicine.

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Pathogens Known

S. pneumoniae

Amoxicillin susceptible:

amoxicillin

HMLSchedNZFPMLnoids

PO 500 mg three times a day

or IV 1 g every eight hours

Amoxicillin MIC 0.12 to 2 mg/L: increased dose required:

amoxicillin

HMLSchedNZFPMLnoids

PO 1000 mg three times a day

or IV 1 g every six hours

Reduced amoxicillin susceptibility: MIC > 2 mg/L - consult Infectious Diseases/Clinical Microbiology.

H. influenzae

amoxicillin

HMLSchedNZFPMLnoids

PO 500 mg three times a day

If beta-lactamase producing

amoxicillin+clavulanic acid

HMLSchedNZFPMLnoids

PO 500 mg/125 mg three times a day

Penicillin allergy

doxycycline

HMLSchedNZFPML

PO 200 mg on day 1

then PO 100 mg once a day

OR (for mild penicillin allergy only)

cefuroxime

HMLSchedNZFPMLnoids

PO 500 mg twice a day

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Topic Code: 99245