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/sulfamethoxazole | β-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 |