Acute Exacerbation of COPD

Safe Prescribing (visit the safe prescribing page)

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.
  • 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 is the preferred choice.
  • EUCAST recommends that infections due to H. influenzae are treated with higher doses of amoxicillin than the standard doses normally used
  • 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
  • Ciprofloxacin is the quinolone of choice if patient known to be colonised with Pseudomonas. N.B check sputum culture and sensitivity results
  • 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.
  • Azithromycin use, particularly if prolonged, is associated with prolonged QT syndrome.See our webpage on Drug Interactions.
  • Ensure all patients offered annual influenza vaccine.
  • Ensure all patients offered pneumococcal vaccine.


COPD treatment table 2019

Patient Information

Visit HPSC Information Leaflets pages for the General Public, (MRSA, CRE, etc)

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 Feb 2020

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