Antibiotic therapy for COPD exacerbations

Llor, 2022Messous, 2022Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2025Dabscheck, 2022

Do not use antibiotic therapy for COPD exacerbations unless the patient meets the criteria for antibiotic therapy – see The role of antibiotic therapy for COPD exacerbations. If antibiotic therapy is indicated, use oral therapy if possibleFanning, 2014. Do not use intravenous antibiotic therapy unless the patient cannot tolerate or absorb oral therapy.

Note: If antibiotic therapy is indicated for a COPD exacerbation, use oral therapy if possible.

The antibiotic dosages for COPD exacerbations are lower than those for community-acquired pneumonia (CAP) because antibiotic therapy for COPD exacerbations aims to hasten recovery, not eradicate airway colonisation (which is common in patients with COPD).

If antibiotic therapy is indicated for a COPD exacerbation, useLlor, 2022Messous, 2022Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2025Dabscheck, 2022:

1amoxicillin 500 mg orally, 8-hourly for 5 days amoxicillin amoxicillin amoxicillin

OR

1amoxicillin 1 g orally, 12-hourly for 5 days amoxicillin amoxicillin amoxicillin

OR

1doxycycline 100 mg orally, daily for 5 days. doxycycline doxycycline doxycycline

Amoxicillin+clavulanate, macrolides and cephalosporins are not recommended for initial therapy of a COPD exacerbation because they are not more effective than amoxicillin or doxycycline, and expose patients and the community to the potential harms associated with unnecessary broader-spectrum treatment (for more detailed advice, see Types of adverse effects of antimicrobials and Antimicrobial use and emergence of resistance)Bagge, 2021.

Lack of response to initial antibiotic therapy for a COPD exacerbation rarely requires switching to broader-spectrum therapy – see Antibiotic management of COPD exacerbations that are not improving.