The Truth About Antibiotics and COPD

A boy uses an inhaler for a breathing problem.
A boy uses an inhaler for a breathing problem.. Medic Image/Getty Images

Many people with COPD either run to the doctor for antibiotics when they anticipate a COPD exacerbation coming on, or keep a prescription of antibiotics on hand if they begin to experience worsening symptoms. But do antibiotics really benefit every patient with COPD? The answer may surprise you.

Shelving the Myth About Antibiotics and COPD

Contrary to popular belief, antibiotics are effective in treating only a select group of patients who experience COPD exacerbations.

People in this group include those who have:

  • An increase in dyspnea, cough and purulent sputum
  • Two of the previously mentioned symptoms, including an increase in purulent sputum
  • Severe exacerbations requiring non-invasive or mechanical ventilation and who have at least one of the previously mentioned symptoms

What About Prophylactic Treatment With Antibiotics?

Over the years, the practice of using prophylactic antibiotics to prevent COPD exacerbation has been a matter of controversy. Recent studies using azithromycin showed that prophylactic antibiotics did reduce the exacerbation rate. But the research also suggests that prophylactic antibiotics are associated with negative side effects that outweigh the benefits. To date, the Global Initiative for Obstructive Lung Disease does not recommend the daily use of antibiotics for the treatment of COPD, except in cases of bacterial infection associated with COPD exacerbation.

That said, COPD patients who continue to have frequent exacerbations despite optimal therapy for COPD (with bronchodilators and anti-inflammatory agents) may be prescribed an antibiotic prophylaxis with azithromycin. If prescribed a prophylactic antibiotic, pay careful attention to side effects and tell your doctor right away if you're have any adverse effects.

Tips for Taking Your Antibiotics

If you've been prescribed an antibiotic, here's how to get the maximum benefit out of the medication:

  • Remember that antibiotics are ineffective in treating infections caused by a virus, such as the common cold or flu.
  • Never take anybody else's antibiotics. Because certain antibiotics target certain bacteria, you can never assume that someone's medication will work for your particular illness.
  • Take the entire course of antibiotics, even if you start to feel better. Stopping too soon may lead to antibiotic resistance and a worsening of your condition.
  • Be sure to read the prescription bottle carefully and follow the directions as per your doctor's instructions. If you don't understand the drug label, talk to your doctor or pharmacist.
  • Be mindful of any precautionary labels attached to the prescription bottle. For example, a label might say for you to avoid sunlight or drink lots of water during antibiotic therapy.
  • Ask your doctor or pharmacist if you should take your antibiotic with food or on an empty stomach. This should also be included on the drug's labeling.
  • Ask your doctor about how to deal with side effects such as nausea and diarrhea. If you are a woman, talk to your doctor about the possibility of developing a yeast infection during antibiotic therapy and what you can do to prevent or treat it.

Even if antibiotics aren't right for your COPD treatment, there are other ways to control your symptoms. Check out these resources for more information:

9 Treatment Options for Very Severe COPD

Complete Guide to COPD Treatment

How to Prevent COPD Exacerbation

List of Common COPD Medications


Albert RK, Connett J, Bailey WC, et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med 2011; 365:689

Briel M. et. al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med. 2008 Oct 13;168(18):2000-7; discussion 2007-8.

K. Kostikas1,A.I. et. al. A typical COPD exacerbation? Breathe. June 2008. Volume 4;No 4.

Puhan MA, et. al. Exacerbations of chronic obstructive pulmonary disease: when are antibiotics indicated? A systematic review. Respir Res. 2007 Apr 4;8:30.

Ram FS et. al. WITHDRAWN: Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD004403.

Stolz D. et. al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest. 2007 Jan;131(1):9-19.

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