Acute bronchitis:
Many cases are viral, and antibiotics are not required in the vast majority of cases. Systematic reviews indicate antibiotics have marginal benefits in otherwise healthy adults. Only consider antibiotics if the patient is >60yrs or there is underlying chest disease.
Doxycycline 200mg stat then 100mg once daily for 5 days OR Amoxicillin 500mg TDS for 5 days.
Acute exacerbation of COPD:
Many cases are viral – consider whether antibiotics are needed. Antibiotics not indicated in absence of purulent/mucopurulent sputum.
Doxycyline 200mg stat then 100mg once daily for 5 days OR Amoxicillin 500mg TDS for 5 days OR Clarithromycin 500mg BD for 5 days.
Use of rotational antibiotics in COPD is very rarely indicated. Standby antibiotics may be offered to patients who suffer frequent exacerbations with severe COPD who have been counselled on how to use these ‘as needed’ antibiotics (doxycycline or amoxicillin or clarithromycin).
Bronchiectasis exacerbation
High dose antibiotics, as advised by the specialist, generally for 2- 4 weeks and taken until the patient’s improvement has plateaued as measured by improvement in sputum volume and purulence.
Community-acquired pneumonia:
Assess severity using an appropriate score (eg CRB65 or CURB65) to help guide and review.
For CAP treatment in the community, consider an initial dose of IV benzylpenicillin. Mycoplasma is rare in over 65s. Consider legionella in travellers. Do not use doxycycline in children or pregnant women.
For non-severe CAP Amoxicillin 500mg TDS for 7 to 10 days OR Doxycycline 200 mg stat then 100 mg once daily for 7 to 10 days OR Clarithromycin 500mg BD for 7 to 10 days.
For severe CAP in a community hospital setting:
Piperacillin/tazobactam 4.5 g IV TDS PLUS Clarithromycin 500 mg BD orally or by infusion if oral route not available.
If history of penicillin allergy: Contact Clinical Microbiology for advice.
Hospital acquired pneumonia in a community hospital setting:
Non severe: amoxicillin 500mg TDS PLUS Doxycyline 200mg stat then 100mg once daily orally for 5-7 days
Severe: Piperacillin/tazobactam 4.5 g IV TDS and then treat according to sensitivities BUT where legionella is suspected ADD Clarithromycin 500mg BD orally or by infusion if oral route not available.
Aspiration pneumonia in a community hospital setting:
Contact Microbiology if MRSA status is positive, otherwise
Community acquired NON SEVERE aspiration pneumonia : Co-amoxiclav 625mg orally TDS for 5-7 days
Hospital acquired SEVERE aspiration pneumonia: Piperacillin/tazobactam 4.5 g IV TDS.