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Remember to check allergy status

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Adult Treatment - Lower Respiratory Tract Infections

Note: Low doses of penicillins are more likely to select out resistance 1, we recommend 500mg of amoxicillin (adults). Do not use quinolone (ciprofloxacin, ofloxacin) first line due to poor pneumococcal activity 2 B-. Reserve all quinolones (including levofloxacin) for proven resistant organisms.

Acute cough, bronchitis

NICE-CKS
NICE 69

Antibiotic little benefit if no co-morbidity 1-4A+
Consider 7d delayed antibiotic with advice 1,5 A
Symptom resolution can take 3 weeks.

Consider immediate antibiotics if older than 80yr and ONE of the following:

-hospitalisation in past year,
-oral steroids,
-diabetic,
-congestive heart failure
OR > 65yrs with 2 of above.

Consider CRP test1A+,4. If CRP <20mg/L no antibiotics, CRP 20-100mg/L delay antibiotics, CRP >100mg/L immediate antibiotics.

Medicine Calendar

amoxicillin

500mg TDS

5 days4A+

Or
doxycycline

200mg stat on Day 1 and from Day 2 onwards, 100mg OD

5 days4A+

Acute exacerbation of COPD

NICE 12
Gold
NICE-CKS

Treat exacerbations promptly with antibiotics if purulent sputum and increased shortness of breath and/or increased sputum volume 1-3 B+.

Risk factors for antibiotic resistant organisms include co-morbid disease, severe COPD, frequent exacerbations, antibiotics in last 3 months. 2

Medicine Calendar

amoxicillin

500mg TDS

5 days 4 C

or
doxycycline

200mg stat on Day 1 and from Day 2 onwards 100mg OD

5 days 4 C

or clarithromycin

500mg BD

5 days 4 A

If resistance: co-amoxiclav

625mg TDS

5 days 4 A

Community acquired pneumonia (treatment in the community)2,3

BTS 2009
Guideline (PDF)

For adults: Use CRB65 score to guide mortality risk, place of care and antibiotics.1

Each CRB65 parameter scores 1:

Confusion (AMT<8);
Respiratory rate >30/min;
BP systolic <90 or diastolic ≤ 60; Age >65;

  • Score 3-4: urgent hospital admission
  • Score 1-2: hospital assessment or admission
  • Score 0: suitable for home treatment

Always give safety-net advice and likely duration of symptoms. Mycoplasma infection is rare in over 65s1

Medicine Calendar

IF CRB65=0:
amoxicillin A+ Or
clarithromycin A-Or
doxycycline D

amoxicillin 500mg TDS or clarithromycin 500mg BD or doxycycline 200mg stat on day 1 then 100mg OD

CRB65=0: use 5 days. Review at 3 days & extend to 7-10 days if poor response

IF CRB65=1,2 and AT HOME
Clinically assess need for dual therapy for atypicals: amoxicillin AND clarithromycin A- or doxycycline alone

amoxicillin 500mg TDS AND clarithromycin 500mg BD or doxycycline 200mg stat on day 1 then 100mg OD

7-10 days

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).