From the Guidelines
Patients with COPD exacerbations should be discharged with antibiotics, such as amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days, doxycycline 100 mg twice daily for 5-7 days, or azithromycin 500 mg on day 1 followed by 250 mg daily for 4 more days, to improve clinical cure and reduce clinical failure 1. The choice of antibiotic should be based on local resistance patterns, affordability, and patient history and preferences, as there is insufficient evidence to support a preferential recommendation 1. Key considerations for discharge antibiotics in COPD exacerbations include:
- The severity of the exacerbation
- Local pattern of resistance
- Tolerability
- Cost
- Potential compliance
- Risk factors for Pseudomonas, such as recent hospitalization, frequent antibiotic use, or severe disease 1 For patients with risk factors for Pseudomonas, consider levofloxacin 750 mg daily for 5-7 days or ciprofloxacin 500-750 mg twice daily for 5-7 days 1. Antibiotics are beneficial because approximately 50% of COPD exacerbations are triggered by bacterial infections, primarily Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae 1. Shorter courses (5-7 days) are as effective as longer courses and reduce antibiotic resistance risk 1. Patients should be instructed to complete the full course even if symptoms improve and to follow up within 1-2 weeks to ensure resolution of the exacerbation. The use of antibiotics in COPD exacerbations has been shown to improve clinical cure and reduce clinical failure, with a pooled effect size showing increased rates of clinical cure at the end of the intervention (odds ratio [OR] = 2.03; 95% CI, 1.47 to 2.80) compared with placebo 1.
From the FDA Drug Label
Adults
- Acute bacterial exacerbations of chronic obstructive pulmonary disease (mild to moderate) 500 mg QD × 3 days OR 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5
The discharge antibiotics for Chronic Obstructive Pulmonary Disease (COPD) with acute exacerbation are azithromycin 500 mg QD × 3 days or azithromycin 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5 2.
From the Research
Discharge Antibiotics for COPD with Acute Exacerbation
- The main cause of exacerbations in COPD is infection, both bacterial and viral, and antibiotics are especially indicated in severe cases and the presence of purulent sputum 3.
- Beta-lactams (amoxicillin-clavulanate and cefditoren) and fluoroquinolones (levofloxacin) are the most widely used antimicrobials for COPD exacerbations 3.
- Prophylactic antibiotics such as macrolides (azithromycin and erythromycin), tetracyclines (doxycyclines), and quinolones (moxifloxacin) may be used to reduce bacterial load, inflammation of the airways, and the frequency of exacerbations in carefully selected patients with COPD 4.
- Macrolides have been shown to reduce exacerbations and improve quality of life in COPD patients, with azithromycin being a commonly used option 4, 5.
- The use of antibiotics in COPD exacerbations should be guided by evidence-based interventions, including appropriate use of antibiotics, bronchodilators, and corticosteroids, to minimize morbidity and mortality associated with the disease 6, 7.