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The Truth About Antibiotics and COPD

Discriminate Use of Antibiotics in COPD Works Best


Updated December 04, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Many people with COPD either run to the doctor when they anticipate a COPD exacerbation coming on, or keep a prescription of antibiotics on hand if they begin to experience worsening symptoms. But do antibiotics really benefit every patient who's having an exacerbation? The answer to this may surprise you.

Shelving the Myth About Antibiotics and COPD

Contrary to popular belief, antibiotics are effective in treating only a select group of patients who experience COPD exacerbations. They don't work for everyone. People in this group include those:

  • who have an increase in dyspnea, cough and purulent sputum
  • who have two of the previously mentioned symptoms, including an increase in purulent sputum
  • who have severe exacerbations requiring non-invasive or mechanical ventilation and who have at least one of the previously mentioned symptoms

What About Prophylactic Treatment With Antibiotics?

Over the years, the practice of using prophylactic antibiotics to prevent COPD exacerbation has been a matter of controversy. Older studies found that continuous use of antibiotics had no effect on the frequency of exacerbations. Recent studies using azithromycin showed that prophylactic antibiotics did reduce the exacerbation rate; the study also showed that prophylactic antibiotics were associated with negative side effects that outweighed the benefits. To date, the Global Initiative for Obstructive Lung Disease (GOLD) does not recommend the daily use of antibiotics for the treatment of COPD, except in cases of bacterial infection associated with COPD exacerbation.

That said, COPD patients who continue to have frequent exacerbations despite optimal therapy for COPD (with bronchodilators and antiinflammatory agents) may be prescribed an antibiotic prophylaxis with azithromycin. If prescribed a prophylactic antibiotic, pay careful attention to contraindications, and keep your doctor promptly informed of any adverse effects. Suspected bacterial exacerbations in patients on antibiotic prophylaxis should be treated with antibiotics that are from a different class than the prophylactic agent. Even if the regimen is successful in reducing exacerbations, interrupting treatment after 48 to 52 weeks should be considered. In addition, patients whose COPD is associated with bronchiectasis may benefit from chronic antibiotic therapy.

Tips for Taking Your Antibiotics

If you've been prescribed an antibiotic, the following tips will help you achieve maximum benefit:

  • Remember that antibiotics are ineffective in treating infections caused by a virus, such as the common cold or flu.
  • Never take anybody else's antibiotics. Because certain antibiotics target certain bacteria, you can never assume that someone's medication will work for your particular illness.
  • Take the entire course of antibiotics, even if you start to feel better. Stopping too soon may lead to antibiotic resistance and a worsening of your condition.
  • Be sure to read the prescription bottle carefully and follow the directions as per your doctor's instructions. If you don't understand the drug label, talk to your doctor or pharmacist.
  • Be mindful of any precautionary labels attached to the prescription bottle. For example, a label might say for you to avoid sunlight or drink lots of water during antibiotic therapy.
  • Ask your doctor or pharmacist if you should take your antibiotic with food or on an empty stomach. This should also be included on the drug's labeling.
  • Ask your doctor about how to deal with side effects such as nausea and diarrhea. If you are a woman, talk to your doctor about the possibility of developing a yeast infection during antibiotic therapy and what you can do to prevent or treat it.


Albert RK, Connett J, Bailey WC, et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med 2011; 365:689

Briel M. et. al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med. 2008 Oct 13;168(18):2000-7; discussion 2007-8.

K. Kostikas1,A.I. et. al. A typical COPD exacerbation? Breathe. June 2008. Volume 4;No 4.

Puhan MA, et. al. Exacerbations of chronic obstructive pulmonary disease: when are antibiotics indicated? A systematic review. Respir Res. 2007 Apr 4;8:30.

Ram FS et. al. WITHDRAWN: Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD004403.

Stolz D. et. al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest. 2007 Jan;131(1):9-19.

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