Which antibiotic is considered frontline for COPD exacerbations with pseudomonal coverage?

• A. Levofloxacin
• B. Azithromycin
• C. Amoxicillin
• D. Doxycycline

Answer: (A)

When COPD exacerbations carry a risk for Pseudomonas infection, the antibiotic choice should provide antipseudomonal activity. Levofloxacin is a fluoroquinolone with reliable coverage against Pseudomonas aeruginosa, in addition to the usual COPD pathogens like Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. Its oral formulation and good bioavailability make it a practical frontline option for outpatient treatment when pseudomonal risk is present. The other options lack consistent pseudomonal coverage—amoxicillin isn’t effective against Pseudomonas, while doxycycline and azithromycin don’t reliably cover it—so they’re not optimal for this scenario. In patients with prior Pseudomonas colonization or more severe disease, escalation to a different antipseudomonal agent or IV therapy may be needed.