Acute Exacerbation of COPD

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC). See guidance on dosing in children for quick reference dosage/weight guide. Refer to drug interactions table for detailed drug interactions for all antimicrobials. Note extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.

Note additional warnings for clarithromycin and fluoroquinolones

Comments from Expert Advisory Committee

  • Acute exacerbations may be triggered a viral or bacterial infection.
  • Initiate short-acting bronchodilator therapy and 5 day course oral prednisolone 40 mg per day or equivalent.
    • Use first line antibiotics at recommended doses if sputum colour changes and increases in volume or thickness.
  • Inadequate doses of penicillins are more likely to select out resistance.
  • Antibiotic choice should be guided by sputum culture and sensitivity (C/S) if available
  • Sputum C/S will help guide second choice in treatment failure
  • In penicillin allergy doxycycline preferred choice.
  • The quinolones e.g levofloxacin, ciprofloxacin are generally not appropriate as first line treatment in the community as there are safer alternatives available, Fluoroquinolone Warning 2019
  • EUCAST recommends that infections due to H. influenzae are treated with higher doses of amoxicillin than the standard doses normally used
  • Ciprofloxacin is the quinolone of choice if patient known to be colonised with Pseudomonas. N.B check sputum culture and sensitivity results
  • Azithromycin use, particularly if prolonged, is associated with prolonged QT syndrome. See our webpage on Drug Interactions.
  • Azithromycin should not be used for prophylaxis / prevention of exacerbations of COPD except under the direction of a respiratory physician.
    It is effective in a very select subgroup of COPD patients
  • Ensure all patients offered annual influenza vaccine.
  • Ensure all patients offered pneumococcal vaccine.

Warnings for clarithromycin and fluoroquinolones


COPD treatment table 2019

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 Dec 2019

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