1.2 Choice of antibiotic
1.2.1
When prescribing an antibiotic for an acute exacerbation of COPD, follow table 1 for adults aged 18 years and over.
1.2.2
Give oral antibiotics first line if the person can take oral medicines, and the severity of their exacerbation does not require intravenous antibiotics.
1.2.3
Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible.
See the BNF for appropriate use and dosing in specific populations, for example, in hepatic impairment, renal impairment, and when administering intravenous antibiotics.
If a person is having antibiotic prophylaxis, treatment should be with an antibiotic from a different class.
Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible.
People who may be at a higher risk of treatment failure include people who have had repeated courses of antibiotics, a previous or current sputum culture with resistant bacteria, or people at higher risk of developing complications.
Co‑trimoxazole should only be considered for use in acute exacerbations of COPD when there is bacteriological evidence of sensitivity and good reason to prefer this combination to a single antibiotic (BNF, co-trimoxazole, October 2018).
See the Medicines and Healthcare products Regulatory Agency advice for restrictions and precautions for using fluoroquinolone antibiotics due to very rare reports of disabling and potentially long-lasting or irreversible side effects affecting musculoskeletal and nervous systems. Warnings include: stopping treatment at first signs of a serious adverse reaction (such as tendonitis), prescribing with special caution in people over 60 years and avoiding coadministration with a corticosteroid (March 2019).