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COPD Exacerbation – Do they also need antibiotic coverage?

COPD exacerbations are commonly seen in the emergency room, urgent care, and primary care setting. Treatment can usually be managed outpatient with the combination of beta adrenergic agonists ( albuterol ) and or with anticholinergic agents ( ipratropium) with MDI or nebulizer, In addition patients are usually prescribed systemic glucocorticoid therapy. Current guidelines suggest a dose or equivelent of prednsione 40mg PO daily x 4 days.
So do you give them antibiotics too? Simple answer, it depends on the ENTIRE picture. It is important to take into consideration the severity of the exacerbation, complications, or risk factors.  COPD patients are at higher risk for pathogens such as H. Influenzae, Moraxella catarrhalis, and Strep Pneumonia.
Here is a chart to help you in your practice follow the GOLD guidelines for antibiotics with patients who are having an acute COPD exacerbation.

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