Therapeutic Handbook - GGC Prescribing

Lower respiratory tract infections (LRTI)(Also see page 138 for management of acute COPD exacerbation.)InfectionsLower respiratory tractinfections (not pneumonia)Infective exacerbation ofCOPDPurulent bronchitisLRTI and pre-existing lungdiseaseSevere / complicatedexacerbation:• Ventilation required or• Sepsis or• Other indication for IVrouteAntibiotic TherapyAmoxicillin oral 500 mg8 hourlyorDoxycycline oral 200 mg asone-off single dose followed by100 mg dailyorClarithromycin* oral 500 mg12 hourlyTotal course duration 5 days.Amoxicillin IV 1 g 8 hourlyorClarithromycin* IV 500 mg12 hourlyReview IV therapy daily. Totalcourse duration 7 days (IV andoral).Notes / CommentsIV administration in sepsis –see note on page 211.Likely organisms:Pneumococcus, Haemophilusinfluenzae, Moraxellacatarrhalis.Antibiotic:• Prescribe antibiotic only ifpurulent sputum.• Antibiotic choice dependson previous antibiotictherapy or if true penicillin/ beta-lactam allergy.*Clarithromycin activity vsHaemophilus is reducedcompared to other agentsClarithromycin – seriousdrug interactions (seeBNF Appendix 1) and QTcprolongationLower respiratory tract infections continue on next pagePage 230