[Not all exacerbations of chronic obstructive pulmonary disease should be treated with antibiotics]

This review gives an update on antibiotic treatment of exacerbation of chronic obstructive pulmonary disease (COPD). Patients who do not need hospital admission and do not present with purulent sputum nor increased levels of C reactive protein/procalcitonin have no beneficial effect of antibiotic treatment. Those with severe COPD and increased sputum purulence should be treated with antibiotics, and first-line treatment should be amoxicillin, which is effective against the most common types of bacteria in COPD exacerbation. In patients with very severe COPD, amoxicillin/clavulanate could also be first-line treatment.