Infective Exacerbation of COPD

Comments from Expert Advisory Committee

• Acute exacerbations may be triggered by a viral or bacterial infection.
• Initiate short-acting bronchodilator therapy and 5 day course oral prednisolone 40 mg per day (30 mg per day if 60kg or less).
• Ensure all patients are up to date with influenza vaccine, COVID-19 vaccine and pneumococcal vaccine.
• Use first line antibiotics at recommended doses if sputum colour changes and increases in volume or thickness.
• Consider sending sputum for culture if frequent exacerbations or infections are slow to resolve. Sputum culture and sensitivity will help guide choice in treatment failure.
• In penicillin allergy, doxycycline is the preferred choice. Macrolide warning.
• The quinolones e.g. levofloxacin, ciprofloxacin are generally not appropriate as first line treatment in the community as there are safer alternatives available. Fluoroquinolone Warning.
• If considering a quinolone in a patient colonised with Pseudomonas spp, ciprofloxacin is the quinolone of choice. Consult microbiologist / infectious diseases physician for treatment choice and dose.
• Azithromycin should not be used for prophylaxis / prevention of exacerbations of COPD except under the direction of a respiratory physician. It is effective in a very select subgroup of COPD patients. 

Treatment

* Alternative doxycycline dose: 100mg every 12 hours. 
In non-severe infection, 200mg stat then 100mg every 24 hours can be considered.

Patient Information

• We recommend patients use the website developed by HSE/ICGP/IPU partnership www.undertheweather.ie for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.
• Patient COPD Communication Card available from NCPC
• COPD Self Care plan
• COPD Support Ireland

Useful Link

• Management of Chronic Obstructive Pulmonary Disease in General Practice Quick Reference Guide (ICGP)
• National Clinical Guideline: Management of COPD (3.09 MB, PDF)

Safe Prescribing (visit the safe prescribing page)

• Doses are oral and for adults unless otherwise stated
• Clarithromycin and other macrolides warning
• Fluoroquinolone warning
• Penicillin allergy – tips on prescribing in penicillin allergy
• Renal impairment dosing table
• Safety in Pregnancy and Lactation
• Drug interactions table. Extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
• Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed October 2021