Acute COPD exacerbation — MRCGP AKT MCQ

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EasyRespiratory MedicineAcute COPD exacerbationMRCGP AKT UKMLA PARA PSA

A 56-year-old man with COPD presents with increased dyspnoea and an increase in sputum volume and purulence. He is clinically stable and can be managed at home. He has a documented immediate hypersensitivity reaction to penicillins, no recent sputum culture showing resistant bacteria and no other contraindication to the listed antibiotics. Which is the most appropriate first-choice oral antibiotic?

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Correct answer: D — Doxycycline

Doxycycline is a NICE first-choice oral antibiotic for an acute COPD exacerbation when antibiotics are indicated. The increased sputum purulence and volume support antibiotic treatment, and immediate penicillin hypersensitivity excludes amoxicillin. Co-amoxiclav also contains a penicillin and is generally reserved for patients at higher risk of treatment failure. Ciprofloxacin is not a recommended empirical option for routine COPD exacerbations; fluoroquinolone use is restricted because of potentially disabling and long-lasting adverse effects. Long-term azithromycin may be considered to prevent frequent exacerbations in selected patients after specialist assessment, but it is not the appropriate acute treatment here.

Reference: NICE. Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing, NG114, section 1.2 and table 1. Published 2018; table updated September 2024. https://www.nice.org.uk/guidance/ng114/chapter/Recommendations