COVID-19

 According to guidelines from NICE that were last reviewed and updated in 2019, many COPD exacerbations are not caused by bacterial infections and will not respond to antibiotics. Antibiotics can be considered in patients with an acute exacerbation of COPD after taking the following into account:

• The severity of symptoms, particularly sputum color changes and increases in volume or thickness beyond the individual's usual day-to-day variation

• Whether the patient may need to be hospitalized for treatment

• The patient's previous exacerbation and hospital admission history

• The patient's risk for developing complications

• Previous sputum culture and susceptibility results

• The risk for antimicrobial resistance with repeated courses of antibiotics

If indicated, oral antibiotics are preferred if the patient can take oral medicines and the severity of the COPD exacerbation does not require intravenous antibiotics. Recommended first-choice oral antibiotics for empirical treatment or guided by most recent sputum culture and susceptibilities include the following:

• Amoxicillin: 500 mg three times a day for 5 days

• Doxycycline: 200 mg on the first day, then 100 mg once a day for a 5-day course in total

• Clarithromycin: 500 mg twice a day for 5 days

If no improvement in symptoms is seen after the first-choice antibiotic is taken for at least 2-3 days, use an alternative first-choice option from a different class.

Alternative choice oral antibiotics in adult patients with acute COPD exacerbations at higher risk for treatment failure include the following:

• Co-amoxiclav: 500/125 mg three times a day for 5 days

• Co-trimoxazole: 960 mg twice a day for 5 days

• Levofloxacin (with specialist advice if co-amoxiclav or co-trimoxazole cannot be used; consider safety issues): 500 mg once a day for 5 days