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What do you need to know about the role antibiotics can play in the treatment of COPD, and how do you recognize the signs that you may need an antibiotic — so you can let your doctor know promptly?

While respiratory infections — which definitely pose a risk to you if you're suffering from chronic obstructive pulmonary disease (COPD) — are generally caused by viruses, for which antibiotics don't do a thing, that doesn't mean antibiotics do not play a role in the management of COPD. Viral infections may leave you more vulnerable to secondary bacterial infections, in part because bacterial colonies have taken up permanent residence in as many as 50 percent of all COPD patients. 

What should people with COPD know about antibiotic treatment?

COPD, viral infections, and bacterial respiratory infections

Because it is harder for your lungs to eliminate bacteria and environmental allergens and irritants, you are more vulnerable to respiratory infections as a COPD patient. These infections can, in turn, damage your lungs further, leading to worsened symptoms. People with COPD are likely to have bacterial colonies living in their lungs, and though they do not automatically cause infection, being struck by a virus means you are also at an increased risk of a bacterial infection. The risk of this type of secondary infection is even higher if you also suffer from another chronic condition.

In addition to having a higher risk of secondary bacterial infections, you're also more prone to developing dangerous primary bacterial infections, such as:

  • Tuberculosis
  • Pneumococcal infections
  • Staphylococcal infections

Red flags: Recognizing the signs of lung infections

Individually, the symptoms of a lung infection may also be caused by other things. Nonetheless, it is important to let your doctor know if you recognize any of them, so you can be diagnosed and receive treatment as soon as possible:

  • A fever — if you have a temperature of 100.4 F or higher (or 38 C or more), that's a sign that your body is fighting something, including a possible lung infection.
  • Your shortness of breath is worse than it usually is. 
  • You have rapid, shallow, breathing
  • You are coughing up more sputum — usually yellow, green, with traces of blood, or an ugly tan color.
  • Your heart rate has increased. 
  • You have chest pain or a feeling of tightness in the chest.

The role of antibiotics in COPD treatment

Acute exacerbations mean increased symptoms, decreased lung function, and other systemic symptoms such as a fever. While they tend to clear up over the course of a few weeks, it may take you several months to regain your quality of life — and even with proper treatment, these exacerbations can be very dangerous, even life-threatening.

Research has shown that taking antibiotics greatly improves the outcome for moderate to severe exacerbations, which means that you'll have at least two of these symptoms:

  • Increased shortness of breath
  • More sputum than usual
  • Purulent sputum — this means pus is present, usually signified by a notorious green or yellow color

If you have only of these three symptoms, meanwhile, your doctor will probably advise you to use your bronchodilator more often, as well as offering relief for other symptoms you may be experiencing. 

What about prophylactic antibiotics?

"Prophylactic" essentially means preventative — dentists may prescribe prophylactic antibiotics to prevent infection following a wisdom tooth extraction, for instance. In the case of COPD, some patients have been prescribed continuous prophylactic antibiotics, while others are offered them intermittently, with the goal of reducing the risk of exerbations.

While research has shown that this approach does indeed lower your odds of exercerbations, antibiotic resistance is now a very serious global health concern. The Global Initiative for Obstructive Lung Disease doesn't advise continious prophylactic antibiotics. Your doctor will, however, look at your own individual risk factors and decide on the right course of action for you. 

However, if you have a respiratory infection and are prescribed antibiotics, you have no need to feel guilty for taking them — you need them! You can still do your bit in the fight against antibiotic resistance by taking your antibiotic exactly as prescribed. This means taking them at the right times and finishing the entire course. 

What antibiotics will you be prescribed if you have COPD?

For moderate to severe COPD exarcerbations, the antibiotic of choice depends on whether your COPD is "simple" or "complicated". For simple COPD, the choices are:

  • Azithromycin
  • Clarithromycin
  • Cefuroxime
  • Cefpodoxime
  • Cefdinir
  • Tefpodoxime
  • Doxycycline
  • Trimethoprim

If you are over 65, also have heart disease, or have suffered three COPD exacerbations or more in the last year, you are considered a complicated patient — meaning the antibiotics above may put you at risk of life-threatening heart rhythm disturbances. In this case, you will instead be prescribed one of these antibiotics:

  • Amoxicillin with clavulanate
  • Moxifloxacin
  • Gemifloxacin
  • Levofloxacin
  • Ciprofloxacin — if you are at risk of Pseudomonas aeruginosa and Enterobacteriaceae infections
Keep in mind that you shouldn't be prescribed an antibiotic you have already taken in the past three months, for any reason including infections not related to your COPD.

Common-sense antibiotic tips

  • Only ever take antibiotics prescribed to you by your doctor — do not buy them over the counter (or rather "under the table", as the case may be — yes, still possible in some countries!) or online, and do not take antibiotics that were prescribed to a friend or relative. Even if you really do need antibiotics, you have to get the right ones!
  • Always finish the entire course, even if your symptoms subside before you are done with it. Not only can abandoning your course cause your symptoms to come back with a vengeance, it also means you contribute to antibiotic resistance.
  • Take the antibiotic exactly as prescribed. Set a timer to make sure you take your doses on time, for instance, take them on an empty stomach or with food as instructed, and refrain from drinking alcohol if needed.  If you have questions about how to take your antibiotic, your doctor or pharmacist can help.
  • Talk to your doctor about possible side effects and how to manage them in advance.

What can you do to avoid antibiotics if you have COPD?

While antibiotics play a vital role in treating bacterial infections and COPD excerbations, it is, of course, best to do what you can to reduce your risk of needing them. You can play your part by:

  • Making sure you're up to date on your vaccines ― not just the annual flu shot, but also a pneumococcal vaccine that protects against pneumonia.
  • Washing your hands frequently and never touching your face with unwashed hands.
  • Staying away from sick people, and asking people to stay away from you when they are sick. During flu season, avoid large crowds. 
  • Staying hydrated. 
  • Regularly cleaning your inhalers, masks, flutter valves, and other medical equipment — allergens and irritants can build up there!
  • Seeking medical attention as soon as you notice the warning signs of a respiratory infection!

  • Miravitlles, M., & Anzueto, A. (2013). Antibiotics for Acute and Chronic Respiratory Infection in Patients with Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine, 188(9), 1052–1057.
  • Wilson, R., Sethi, S., Anzueto, A., & Miravitlles, M. (2013). Antibiotics for treatment and prevention of exacerbations of chronic obstructive pulmonary disease. Journal of Infection, 67(6), 497–515.
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