COPD
COPD Exacerbation Antibiotics
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COPD Exacerbation Antibiotics
, Antibiotic Use in COPD Exacerbation
See Also
Acute Exacerbation of Chronic Bronchitis
COPD
Chronic Bronchitis
Emphysema
Alpha-1-Antitrypsin Deficiency
COPD Staging
COPD Management
COPD Exacerbation Prevention
COPD Action Plan
Indications
Antibiotic indications if 3 criteria met
Increased
Dyspnea
(or requiring
NIPPV
or Intubation)
Increased
Sputum
Purulent Sputum
Management
Antibiotics for Uncomplicated
Chronic Bronchitis
Criteria
Under age 65 years old
FEV1
> 50% of predicted
Under 4 acute exacerbations per year
No significant comorbid disease
Coverage
Haemophilus
Influenza
e
Streptococcus Pneumoniae
Moraxella catarrhalis
Chlamydia pneumoniae
Mycoplasma pneumoniae
Antibiotics (5 day course)
First-Line
Trimethoprim-Sulfamethoxazole (
Bactrim
DS,
Septra
DS) one tablet orally twice daily
Amoxicillin
1000 mg orally twice daily
Equivalent to
Moxifloxacin
in clinical outcome
Wilson (2004) Chest 125:953-64 [PubMed]
Alternative Antibiotics
Augmentin
875 mg orally twice daily
Second generation
Macrolide
Clarithromycin
500 mg PO bid
Azithromycin
500 mg day 1, then 250 mg PO x4 days
Also available as 3 day preparation
Similar outcomes to
Levofloxacin
for 7 days
Amsden (2003) Chest 123:772-7 [PubMed]
Other antibiotics
Doxycycline
100 mg orally twice daily
No longer recommended in
COPD
exacerbation due to lack of efficacy
Sethi and Murphy in Ramirez, Management of infection in exacerbations of
COPD
, UpToDate, accessed 11/24/2022
van Velzen (2017) Lancet Respir Med 5(6):492-9 +PMID: 28483402 [PubMed]
Management
Antibiotics for Complicated
Chronic Bronchitis
Criteria
Uncomplicated criteria not met (see above)
Coverage
Uncomplicated
Chronic Bronchitis
Bacteria
(see above)
Gram Negative Rod
s (e.g.
Pseudomonas
)
Dosing for 5 day course
Augmentin
875 mg PO bid
Fluoroquinolone
Levofloxacin
(
Levaquin
) 250 mg po qd
Moxifloxacin
(
Avelox
) 400 mg PO qd
Management
Antibiotics for Severe Exacerbation requiring hospitalization
Co-administer
Corticosteroid
s
Initially use intravenous
Corticosteroid
s
Methylprednisolone
(Solumedrol) 60 mg IV every 6 hours
Avoid high doses (e.g. 125 mg) as they offer no added benefit
Transition to oral
Corticosteroid
s as soon as prudent
Prednisone
30-40 mg orally daily
Taper off over 2 weeks (no benefit to previously used longer taper over 8 weeks)
Protocol: Two
Parenteral
drug combination
Drug 1:
Cephalosporin
or Antipseudomonal
Penicillin
Drug 2:
Fluoroquinolone
or
Aminoglycoside
Cephalosporin
s
Ceftriaxone
(
Rocephin
) 1 to 2 grams IV q24 hours
Cefotaxime
(
Claforan
) 1 gram IV q8-12 hours
Ceftazidime
(
Fortaz
) 1-2 grams IV q8-12 hours
Antipseudomonal
Penicillin
s
Piperacillin
-Tazobactam (
Zosyn
) 3.375 g IV q6 hours
Ticarcillin
-Clavulanate (
Timentin
) 3.1 g IV q4-6 hour
Fluoroquinolone
s
Levofloxacin
(
Levaquin
) 500 mg IV q24 hours
Gatifloxacin
(
Tequin
) 400 mg IV q24 hours
Aminoglycoside
Tobramycin
(
Tobrex
)
Split dosing: 1 mg/kg IV q8-12 hours
Once daily: 5 mg/kg IV q24 hours
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