Acute Exacerbation of Chronic Obstructive Pulmonary Diseases (COPD)

Clinical definition:

Acute or subacute worsening of dyspnea (greater than or equal to 5 on a visual analogue scale that ranges from 0 to 10) sometimes but not necessarily accompanied by increased cough, sputum volume, and/or sputum purulence.


Preferred antibiotic choice(s) – Mild-moderate disease
Amoxicillin (PO)Powder for oral liquid: 125 mg (as trihydrate)/5 mL; 250 mg (as trihydrate)/5 mL; Solid oral dosage form: 250 mg; 500 mg (as trihydrate)500 mg 8 hourly5 days
Doxycycline (PO)Oral liquid: 25 mg/5 mL; 50 mg/5 mL (anhydrous); Solid oral dosage form: 50 mg; 100 mg (as hyclate)200 mg STAT then 100 mg 12 hourly5 days
Preferred antibiotic choice(s) – Severe disease
Amoxicillin + clavulanic acid (PO)Oral liquid: 125 mg amoxicillin + 31.25 mg clavulanic acid/5 mL AND 250 mg amoxicillin + 62.5 mg clavulanic acid/5 mL; Tablet: 500 mg (as trihydrate) + 125 mg (as potassium salt)500 mg of amoxicillin component 8 hourly5 days
In case of confirmed drug allergy or medical contraindication in severe disease
AzithromycinCapsule: 250 mg; 500 mg (anhydrous); Oral liquid: 200 mg/5 mL500 mg daily3 days


Principles of Stewardship:

  • Up to 50% of infection-related acute exacerbations are viral. Biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) may play a role in differentiating, when available.


  • Exacerbations of COPD are commonly non-infectious and require optimization of non-antimicrobial therapeutic management.