GGC Medicines

Adult Therapeutics Handbook

Infective exacerbation of COPD (severe / complicated)
Lower respiratory tract infections (LRTI)

Severe / complicated COPD exacerbation:

  • Ventilation required or
  • Sepsis or
  • Other indication for IV route
    • Obtain respiratory samples for microbiology (sputum) and virology (throat gargle) and consider influenza during peak season. If clinical suspicion of influenza please refer to Health Protection Scotland Influenza guidelines for latest treatment options.
Antibiotic Therapy (before prescribing, carefully read the Notes / Comments section below)

Amoxicillin IV 1g 8 hourly


Clarithromycin* IV 500mg 12 hourly

Total course duration (IV and oral): 5 days.

Notes / Comments

IV administration in sepsis – see note here.

Review IV therapy daily, see IVOST policy.

Likely organisms - pneumococcus, Haemophilus influenzae, Moraxella catarrhalis.

Antibiotic therapy:

  • Prescribe only if purulent sputum.
  • Choice depends on previous antibiotic therapy or if true penicillin / beta-lactam allergy.


  • Activity vs Haemophilus is reduced compared to other agents
  • Serious drug interactions (see BNF Appendix 1) and QTc prolongation.

Content last updated February 2021