Treatment of exacerbations of COPD

a. Treat for 10-14 days.

b. Trimethoprim/Sulfamethoxazole (Septra DS) 160/800 mg PO bid.

c. Amoxicillin/clavulanate (Augmentin) 500 mg tid or 875 mg PO bid [250,500,875 mg]; stable against beta lactamases; gastrointestinal side effects (diarrhea) are common.

d. Cefuroxime axetil (Ceftin), 250-500 mg PO bid; good activity against primary pathogens; stable against beta lactamase.

e. Cefixime (Suprax), 200 mg PO bid or 400 mg PO qd; stable against beta lactamase, lacks Staphylococcus aureus coverage.

f. Azithromycin (Zithromax), 500 mg on day 1, then 250 mg PO qd; reserved for treatment of infections due to Mycoplasma, Chlamydia, Legionella species.

g. Clarithromycin (Biaxin), 250-500 mg bid; moderate activity against H influenzae.

h. Levofloxacin (Levaquin) 500 mg PO qd. Broad spectrum coverage.

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