Antibiotic choice for COPD exacerbations
| Clinical presentation | Risk factors | Suggested antibiotic |
|---|---|---|
| Uncomplicated exacerbation (determined by risk factors) | Age < 65 FEV1 > 50% No cardiac disease < 3 exacerbations per year | Macrolide or 2nd- or 3rd-generation cephalosporin |
| Complicated exacerbation | Age ≥ 65 FEV1 ≤ 50% Comorbidity ≥ 3 exacerbations per year | Respiratory fluoroquinolone or Combined amoxicillin and clavulanic acid |
| At risk for Pseudomonas infection | FEV1 ≤ 50% Known infection with Pseudomonas Bronchiectasis Prior antibiotic and steroid use | Antipseudomonal fluoroquinolone |
Information based on Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med 2008; 359:2355–2365 and Anzueto A. Primary care management of chronic obstructive pulmonary disease to reduce exacerbations and their consequences. Am J Med Sci 2010; 340:309–318.