Table 2

 Antibiotic treatment in exacerbations (taken from GOLD10)

Oral treatment (no particular order)Alternative (no particular order)Parenteral treatment (no particular order)
Group A: Patients not needing hospitalisation
>(mild COPD)
Patients with only one cardinal symptom should not receive antibiotics
If indication then:
β-lactam (ampicillin/amoxicillin) Tetracycline Trimethoprim/sulfamethoxazoleβ-lactam/β-lactamase inhibitor
>(Co-amoxiclav) Macrolides: azithromycin,
>clarithromycin, roxithromycin Cephalosporins (2nd or 3rd generation) Ketolides (telithromycin)
Group B: Patients admitted to hospital (moderate to very severe COPD without risk of
>P aeruginosa)
β-lactam/β-lactamase inhibitor
>(Co-amoxiclav)
Fluoroquinolones: gatifloxacin,
>gemifloxacin, levofloxacin, moxifloxacin
β-lactam/β-lactamase inhibitor
>(Co-amoxiclav, ampicillin/sulbactam) Cephalosporins (2nd or 3rd generation) Fluoroquinolones: gatifloxacin, levofloxacin, moxifloxacin
Group C: Patients admitted to hospital (moderate to very severe COPD with risk of
>P aeruginosa)
Fluoroquinolones: ciprofloxacin, levofloxacin (high dose)Fluoroquinolones: ciprofloxacin, levofloxacin (high dose) or β-lactam with P aeruginosa activity