Table 3.

  Canadian Antibiotic Recommendations for Purulent Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) ⁵⁴

Category	Clinical State	Symptoms and Risk Factors	Pathogens	Antibiotics *
Simple exacerbation	COPD without risk factors	Increased mucopurulent sputum and dyspnea	H. influenzae H. species S. pneumoniae M. catarrhalis	Amoxicillin Cephalosporins (2nd/3rd generation) Doxycycline Macrolides (extended‐spectrum) Trimethoprim/sulfamethoxazole (in alphabetical order)
Complicated exacerbation	COPD with risk factors	As in simple, plus at least one of the following:  • forced expiratory volume in 1 second <50% predicted  • Ischemic heart disease  • Use of home oxygen  • Chronic oral corticosteroid use	As in simple plus:  •Klebsiella species and gram‐negative  • Increased probability of beta‐lactam resistance  •Pseudomonas species	Respiratory fluoroquinolone (gemifloxacin, levofloxacin, or moxifloxacin) Beta‐lactam/beta‐lactamase inhibitor (in order of preference)

^* Repeat course of antibiotics of the same class should be avoided within a 3‐month interval.