Infective Exacerbation of COPD

• For investigation and treatment guidelines for Chronic Obstructive Pulmonary Disease (COPD) see Hospital HealthPathways.

Pathogens

• Common: Viruses, S. pneumoniae, H. influenzae
• Other: Moraxella catarrhalis

Drug Treatment

• Antimicrobials are only indicated when there is an increase in purulence together with an increase in sputum volume and/or dyspnoea.
• Tailor antimicrobial choice against recent susceptibility testing, where available.
• Give antimicrobials orally unless the patient is unable to swallow. If the patient has sepsis or concurrent severe pneumonia refer to these guidelines:
  • Sepsis
  • Community Acquired Pneumonia
• If initiating with IV treatment, aim for an early switch from IV to oral antimicrobials.
• Duration: Usually 5 days but variable depending on clinical response.

Empiric

amoxicillin HMLSchedNZFPMLnoids Amoxicillin F: 0.9 Half life: 2 hours Elimination: renal fe: 0.9

PO 500 mg three times a day

• fe = 0.9, consider adjusting dose if CrCl is reduced.

OR, if unable to swallow:

• fe = 0.9, consider adjusting dose if CrCl is reduced.

Penicillin allergy

doxycycline HMLSchedNZFPML Doxazosin F: 0.7 Half life: 12 hours Elimination: CYP3A fe: 0.1

PO 200 mg on day 1 then PO 100 mg once a day

• Metabolised by unknown pathways. (fe = 0.4).
• Avoid in pregnancy and breastfeeding.

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

cefuroxime HMLSchedNZFPMLnoids Cefuroxime F: 0.4 Half life: 2 hours Elimination: renal fe: 0.9

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

• fe = 0.9, consider adjusting dose if CrCl is reduced.

Non-response to amoxicillin:

amoxicillin+clavulanic acid HMLSchedNZFPMLnoids Amoxicillin+Clavulanic Acid F: 0.9 / 0.5 Half life: 2 hours / 1 hour Elimination: renal fe: 0.9 / 0.5

PO 500 mg/125 mg three times a day

• fe (amoxicillin) = 0.9, fe (clavulanic acid) = 0.5, consider adjusting dose if CrCl reduced.

OR, if unable to swallow:

• fe (amoxicillin) = 0.9, fe (clavulanic acid) = 0.5, consider adjusting dose if CrCl reduced.

Severe penicillin allergy

Consult Infectious Diseases/Clinical Microbiology/Respiratory Medicine.

Pathogens Known

S. pneumoniae

Amoxicillin susceptible:

• fe = 0.9, consider adjusting dose if CrCl is reduced.

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

• fe = 0.9, consider adjusting dose if CrCl is reduced.

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

H. influenzae

• fe = 0.9, consider adjusting dose if CrCl is reduced.

If beta-lactamase producing

• fe (amoxicillin) = 0.9, fe (clavulanic acid) = 0.5, consider adjusting dose if CrCl reduced.

Penicillin allergy

• Metabolised by unknown pathways. (fe = 0.4).
• Avoid in pregnancy and breastfeeding.

OR (for mild penicillin allergy only)

• fe = 0.9, consider adjusting dose if CrCl is reduced.
• Cefuroxime is not funded for this indication on prescription – ask your ward pharmacist to supply on discharge.

Topic Code: 99245

must be prescribed or recommended by a consultant.