Acute Exacerbation of COPD

Avoid tetracyclines in pregnancy.

Low doses of penicillins are more likely to select out resistance.

The quinolones ciprofloxacin and ofloxacin have poor activity against pneumococci. However, they do have use in PROVEN pseudomonal infections. Moxifloxacin and Levofloxacin has some anti-Gram-positive activity but should not be needed as first line treatment

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Authority website for drug SPCs, dosage, contraindications, interactions (or IMF/BNF/BNFC/MIMS) - Healthcare professionals should use a range of reference sources to inform their prescribing decisions.  See guidance on dosing in children for quick reference dosage/weight guide.

Letters indicate strength of evidence range from A+ (systematic review) to D (informal opinion).

Statins can interact with some antibiotics and increase the risk of rhabdomyolysis. Amiodarone and drugs which prolong the QT interval can interact with many antibiotics. Many antibiotics increase the risk of bleeding with anticoagulants. Please refer to our Drug Interactions Table for further information.

Comments from Expert Advisory Committee

  • 30% viral, 30-50% bacterial, rest undetermined.
  • Use antibiotics if increased dyspnoea and increased purulence of sputum volume. B+
  • In penicillin allergy use clarithromycin if doxycycline contraindicated.
  • Azithromycin use, particularly if prolonged, is associated with prolonged QT syndrome.  It should not be used for the prevention of exacerbations of COPD except under the direction of a respiratory physician.


Treatment Dose TX Duration
amoxicillin 500 mg TDS 5 days
OR doxycycline 200mg stat/100mg OD 5 days
OR clarithromycin 500 mg BD 5 days
If clinical failure to first line antibiotics, previous amoxicillin exposure <3 months, or severe symptoms (also consider hospital referral):
co-amoxiclav 625 mg TDS 5 days

See guidance on dosing in children for quick reference dosage/weight guide

Patient Information

The HSE Health A-Z website provides patient information on many hundreds of conditions and treatments.

We recommend patients use the website developed by HSE/ICGP/IPU partnership for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.

Reviewed November 2017

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