Table 2.

Application of antibiotics at each stage of AECOPD

COPD stage of acute exacerbation	Microorganisms	Antibiotics
GOLD stages I and II	Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis	Penicillin, beta lactamase/enzyme inhibitor (amoxicillin/clavulanic acid), macrolides (clarithromycin, roxithromycin, azithromycin), first generation (cefazolin, cefradine) or second generation cephalosporins (cefuroxime, cefaclor), doxycycline, levofloxacin.
GOLD stages III and IV; no risk factors for infection with Pseudomonas aeruginosa	Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, Klebsiella pneumoniae, Escherichia coli, Enterobacteriacea	Beta-lactam/enzyme inhibitor (cefuroxime), second generation cephalosporins, fluoroquinolones (levofloxacin, moxifloxacin, gatifloxacin), third generation cephalosporins (ceftriaxone, cefotaxime).
GOLD stages III and IV; risk factors for infection with Pseudomonas aeruginosa	All above microorganisms plus Pseudomonas aeruginosa	Third generation cephalosporins (ceftazidime), cefoperazone/sulbactam, piperacillin/tazobactam, imipenem, meropenem, can also be combined with aminoglycosides, fluoroquinolones (ciprofloxacin).

Abbreviations: AECOPD acute exacerbation of chronic obstructive pulmonary disease, COPD chronic obstructive pulmonary disease, GOLD Global Initiative for Chronic Obstructive Lung Disease.