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. 2008 Jan-Feb;15(Suppl A):1A–8A. doi: 10.1155/2008/641965

TABLE 5.

Antibiotic treatment recommendations for purulent acute exacerbations of chronic obstructive pulmonary disease (COPD)

Group Basic clinical state Symptoms and risk factors Probable pathogens First choice
Simple exacerbation COPD without risk factors Increased sputum purulence and dyspnea Haemophilus influenzae, Haemophilus species, Moraxella catarrhalis, Streptococcus pneumoniae Amoxicillin, second- or third- generation cephalosporins, doxycycline, extended-spectrum macrolides, trimethoprim/sulfamethoxazole (in alphabetical order)
Complicated exacerbation COPD with risk factors As in simple plus at least one of:

  • FEV1<50% redicted

  • ≥4 exacerbations per year

  • Ischemic heart disease

  • Use of home oxygen

  • Chronic oral steroid use

 As in simple plus:

  • Klebsiella species and other Gram-negatives

  • Increased probability of beta-lactam resistance

  • Pseudomonas species

 Fluoroquinolone, beta-lactam/beta-lactamase inhibitor (in order of preference)

Repeat prescriptions of the same antibiotic class should be avoided within a three-month interval. FEV1 Forced expiratory volume in 1 s