Overview of Antibiotics for the Treatment of COPD Exacerbations
COPD exacerbations can be scary and overwhelming. If you have experienced more than one exacerbation during your health journey, you've likely been prescribed various antibiotics. There are several antibiotics that can be used to treat COPD exacerbations. The following will outline the most common antibiotics used.
Prescribing an antibiotic
How is the choice of an antibiotic made?
The choice of treatment is predominately based on selecting the right drug to treat the most likely pathogen (in this case, a bacterium) that is colonizing the lungs. I often get asked by patients whether the antibiotic they have been prescribed is “strong”. The answer is, that antibiotics are not classified as “weak” or “strong”, but rather, are classified based on the pathogens they can eradicate.1
Other factors influencing treatment choice
- Inpatient vs. outpatient. Whether you are being prescribed the drug as an outpatient (drug will be taken at home) or inpatient (receiving drug in hospital) influences treatment choice. This is because some antibiotics can only be administered in hospital settings.
- Current medical conditions and allergies. These also affect the choice of an antibiotic. Antibiotics are the most common culprit for drug-related allergies. Many of these antibiotics also have the potential for drug-drug interactions with current medications, so your doctor will attempt to select the safest agent for you.
- Local resistance patterns. Some drugs are more likely to be resistant to certain pathogens. Because of this, some drugs used in North America, for example, are not used in other countries. For example, amoxicillin is not usually used for COPD exacerbations because it does not work well against the culprit pathogens.2
- Recent use of the same antibiotic. Some doctors are hesitant to prescribe an antibiotic that you have already used within the last 3 months. This is because this practice can increase the risk of resistance to the drug class, meaning the antibiotic will not work well.3
Having said that, I have seen the same antibiotic given to the same patient within a three-month period with success. Therefore, this is not a strict rule.
Most common outpatient antibiotics
Macrolide class
Azithromycin and clarithromycin, or Zithromax and Biaxin respectively, are common antibiotics used. They have favorable dosing, dosed once daily for azithromycin or up to twice daily for clarithromycin.4
A potential concern for this class of medications is the risk of QTC prolongation, which is a heart rhythm disorder that can occur in some high-risk individuals. If you have drug interactions and are of older age, your doctor may decide to avoid this class of drugs to reduce the risk of heart abnormalities.5
Amoxicillin-Clavulanate
This drug is commonly known as amoxiclav and is a combination drug. It is more effective than amoxicillin alone for COPD exacerbations. This drug is typically dosed twice to three times a day and must be taken with food. Diarrhea is a common side effect. Of note, people with a severe penicillin allergy cannot take this medication.6
Fluoroquinolone class
This class of medications includes ciprofloxacin and levofloxacin. These drugs have unique administration requirements; for example, they should not be taken within 2 hours of dairy (i.e., milk and yogurt) products, and should be taken on an empty stomach.7Over time, you may start to recognize the name of these medications. Is there a specific antibiotic that is often prescribed for your exacerbations? Share your experiences below!
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