The role of long-term antibiotic therapy for COPD exacerbations

Note: Refer patients who have frequent exacerbations despite optimal COPD management to a respiratory physician.

Refer patients with chronic obstructive pulmonary disease (COPD) who have frequent exacerbations despite optimal COPD management to a respiratory physician for consideration of long-term oral antibiotic therapy.

Long-term antibiotic therapy with a low-dose oral macrolide reduces the frequency of exacerbations and may improve health-related quality of lifeDabscheck, 2022Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2025Herath, 2018Janjua, 2021Ni, 2015Wedzicha, Calverley, , 2017. Before considering long-term oral macrolide therapy, the respiratory physician should exclude nontuberculous mycobacteria infections and assess the benefits and potential harms of antibiotic therapy (eg adverse effects, the development of antibiotic resistance).

Evidence is lacking to support the use of other antibiotics to prevent COPD exacerbations, including fluoroquinolones and tetracyclinesHerath, 2018Janjua, 2021.

If a long-term macrolide is used, it is essential to monitor for adverse effects and tolerability (eg gastrointestinal upset, hearing impairment, prolonged QT interval). Review the benefits and harms of long-term therapy after 6 months and after each exacerbation.