Antimicrobial therapy is only recommended in:

  • Patients with an acute exacerbation exhibiting:
    • All 3 cardinal symptoms (below)
    • 2 of 3 cardinal symptoms if increased sputum purulence is one of them OR
  • Patients who require mechanical ventilation (invasive or non-invasive)
  1. Increased dyspnea 
  2. Increased sputum volume 
  3. Increased sputum purulence

If patient has been on antimicrobial therapy in the last 3 months (regardless of clinical success) the therapy chosen should be a regimen based on a different mechanism of action


  • No risk factors
  • Patient characteristics include: 
    • age less than 65 years
    • FEV1 greater than 50% predicted
    • less than 4 exacerbations/year
    • no cardiac disease
    • no radiographic evidence of pneumonia

At least 1 of the following: 

  • age greater than 65 years
  • FEV1 less than 50% predicted
  • 4 or more exacerbations/year
  • cardiac disease
  • use of home oxygen
  • chronic use of corticosteroids
  • antibiotic use in past 3 months
  • FEV1 less than 35% predicted
  • Bronchiectasis
  • Recent hospitalization
  • Multiple courses of antibiotics

More Information

  • Approved: PD&T November 2, 2021
  • Next review: November 2024

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2. Vogelmeier, C. F. et al. (2017). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. European Respiratory Journal, 49(3), 1700214. 

3. Bourbeau, J. et al. (2019). Canadian Thoracic Society Clinical Practice Guideline on pharmacotherapy in patients with COPD – 2019 update of evidence. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 3(4), 210–232. 

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7. Sethi S, Murphy TF. Management of infection in exacerbations of chronic obstructive pulmonary disease. UpToDate. Accessed February 2021. 

8. Anti-infective Review Panel. (2013). Anti-Infective Guidelines for Community-Acquired Infections. Toronto: MUMS Guideline Clearinghouse. 

9. Blondel-Hill E, Fryters S. (2021). Acute exacerbation of chronic bronchitis (AECB). Bugs & Drugs. Accessed February 2021. 

10. NB Provincial Health Authorities Anti-Infective Stewardship Committee. (2019). Antimicrobial Therapy for Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Accessed February 2021. 

11. Auwaerter PG. (2020). Exacerbations of Chronic Obstructive Pulmonary Disease (COPD). Johns Hopkins ABX Guide. Accessed February 2021.