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Typical dosing of oral empiric antibiotics for COPD exacerbations

Typical dosing of oral empiric antibiotics for COPD exacerbations
Antibiotic class and agent Oral dosing*
Macrolides
Azithromycin 500 mg on day 1, then 250 mg once daily for 4 days or 500 mg once daily for 3 days
Clarithromycin 500 mg (immediate-release) twice daily or 1 g (extended-release) once daily
Cephalosporins
Cefuroxime (2nd generation cephalosporin) 500 mg twice daily
Cefdinir (3rd generation cephalosporin) 300 mg twice daily or 600 mg once daily
Cefpodoxime (3rd generation cephalosporin) 200 mg twice daily
Beta-lactamase inhibitor combination
Amoxicillin-clavulanate 875 mg/125 mg twice daily or 500 mg/125 mg three times per day
Respiratory fluoroquinolones
Levofloxacin

Without risk factors for Pseudomonas infection: 500 mg once daily

With risk factors for Pseudomonas infection: 750 mg once daily
Moxifloxacin 400 mg once daily
Other fluoroquinolone
Ciprofloxacin 750 mg twice daily (anti-Pseudomonas dosing)
The duration of therapy for patients who are clinically improving is generally 5 days. However, azithromycin can be given for as few as three days when administered at a dose of 500 mg orally daily because of its long half-life.
This table is for use in conjunction with UpToDate content on the management of pulmonary infection in Chronic Obstructive Pulmonary Disease. For additional information, please refer to relevant UpToDate topics and the accompanying algorithms on indications for and selection of empiric antibiotic therapy. Trimethoprim-sulfamethoxazole is a reasonable alternative to the other agents listed in this table but is not preferred because trial data suggest it may be less effective.
* Dosing is intended for adults with normal kidney function. For dose adjustments, refer to the drug monographs included within UpToDate.
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