Infective Exacerbation of COPD

Comments from Expert Advisory Committee

  • Acute exacerbations may be triggered by a viral or bacterial infection.
  • Initiate short-acting bronchodilator therapy and 5 day course oral prednisolone 40 mg per day (30 mg per day if 60kg or less).
  • 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. Macrolide warning.
  • 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.
  • Ciprofloxacin is the quinolone of choice if patient known to be colonised with Pseudomonas spp. Check sputum C/S 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. More information on our Drug Interactions page.
  • Ensure all patients offered annual influenza vaccine.
  • Ensure all patients offered pneumococcal vaccine.


COPD table040321_3

* Alternative doxycycline dose: 100mg every 12 hours. 
In non-severe infection, 200mg stat then 100mg every 24 hours can be considered.

Patient Information

Useful Link

Management of Chronic Obstructive Pulmonary Disease in General Practice Quick Reference Guide (ICGP)

Safe Prescribing (visit the safe prescribing page)

Reviewed February 2021

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