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).
- Use first line antibiotics at recommended doses if sputum colour changes and increases in volume or thickness.
- Antibiotic choice should be guided by sputum culture and sensitivity (C/S) if available.
- Sputum C/S will help guide second 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.
- Ciprofloxacin is the quinolone of choice if patient known to be colonised with Pseudomonas spp. Check sputum C/S results.
- 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.
- Azithromycin use, particularly if prolonged, is associated with prolonged QT syndrome. More information on our Drug Interactions page.
- Ensure all patients offered annual influenza vaccine.
- Ensure all patients offered pneumococcal vaccine.
* Alternative doxycycline dose: 100mg every 12 hours.
In non-severe infection, 200mg stat then 100mg every 24 hours can be considered.
Management of Chronic Obstructive Pulmonary Disease in General Practice Quick Reference Guide (ICGP)
Reviewed February 2021