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​​​Acute Infective Exacerbations of COPD
 
Causative organisms: Haemophilus infuenzae, Streptococcus pneumoniae, Moroxella catarallis
 


Only prescribe an antibiotic if at least 2 of the following are present:​
1 Increased breathlessness
​2 ​Increased sputum production
​3 ​Purulent sputum
 

 
First Line
Second Line
Allergy status
(Confirm allergy status prior to choosing antimicrobial regime)
 
No penicillin allergy
 

OR

On amoxicillin before admission
Antimicrobial
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Check for interactions
 
 
Amoxicillin 
 
 
 Doxycycline*
Dose
 1000mg every 8 hours
 200mg stat, then 100mg every 12 hours
Route
 PO
 PO
Duration
​5 days
 

​*Doxycycline is ineffective if given with multi-valent cation containing products e.g. antacids, supplements or feeds containing calcium, iron, magnesium, zinc, sucralfate or bismuth. These products bind to doxycycline and reduce its absorption by up to  90%.
 
If patients are prescribed antacids or supplements containing calcium iron, magnesium zinc or bismuth. It is advised these medications are stopped/withheld for the duration of antibiotic treatment. If this is not possible due to a clinical need, then an alternative antibiotic must be considered.
If doxycycline and a cation containing product must be prescribed together:
·         Administration times should be as far apart as possible
·         Reduce the dosing frequency of the interacting product if possible
·         In the case of oral nutritional supplements, multiple sips throughout the day should be replaced with set administration times to enable adequate spacing from oral antibiotic administration
·         If a patient is receiving an enteral feed doxycycline should generally be avoided unless there is a specific feed free window