Which initial antimicrobial treatments are recommended for patients admitted to hospital with chronic obstructive pulmonary disease(COPD) exacerbations?
| Group | Definition | Oral treatment | Alternative | Parenteral treatment |
| A# | Mild COPD without comorbidity | Usually no treatment. If indication then: amoxicillin, tetracycline | Co-amoxiclav | |
| Macrolide | ||||
| Levofloxacin+ | ||||
| Moxifloxacin+ | ||||
| B | Moderate–severe COPD without risk factors for P. aeruginosa | Co-amoxiclav | Levofloxacin | Amoxicillin-clavulanate, second or third Generation cephalosporin§, levofloxacin, moxifloxacin |
| Moxifloxacin | ||||
| C¶ | Moderate or severe COPD with risk factors for P. aeruginosa | Ciprofloxacin | Ciprofloxacin or β-lactamƒ with P. aeruginosa activity ± aminoglycosides## |
P. aeruginosa: Pseudomonas aeruginosa. #: usually patients from Group A do not require hospitalisation. In countries with high incidence of Streptococcus pneumoniae resistant to penicillin, high dosages of amoxicillin or amoxicillin-clavulanate are recommended; ¶: a benefit for empirical anti-pseudomonal antibiotic therapy in the presence for risk factors for P. aeruginosa is not proven; +: moxifloxacin and levofloxacin offer better coverage against S. pneumoniae than ciprofloxacin; §: ceftriaxone and cefotaxime; ƒ: cefepime, piperacillin-tazobactam or a carbapenem; ##: there is no data on the benefit of combination therapy for P. aeruginosa treatment in exacerbated COPD patients.