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

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 Feb 2020

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