Efficacy of antibiotic therapy in severe acute exacerbation of COPD: A clinical study

Asmir Aldžić, Marija Radić, Emina Bajramović

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) represent a major challenge in pulmonary practice, as they contribute to disease progression, frequent hospitalizations, and increased mortality. Despite advances in treatment, acute exacerbations continue to significantly affect the functional capacity and quality of life of affected patients.

The aim of this study was to evaluate the efficacy of empirical antibiotic therapy with a combination of amoxicillin and clavulanic acid (AMK) in hospitalized patients with severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Particular attention was given to the dynamics of inflammatory biomarkers — C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and leukocyte count (Le) — along with assessment of microbiological response. All participants had severe underlying disease, stage III/IV according to GOLD 2025.

This prospective study was conducted from May to June 2025 and included 38 patients with severe COPD and clinically significant exacerbation. The therapeutic protocol included oral administration of amoxicillin/clavulanic acid (875/125 mg) twice a day for seven days. Clinical and laboratory parameters were monitored at three time points.

During therapy, a statistically significant reduction in all inflammatory markers was recorded: CRP decreased from 71.3 to 8.7 mg/L, ESR from 66.3 to 23.4 mm/h, and leukocyte count from 13.5 to 8.45 $\times 10^9$/L. Positive sputum cultures were found in 13.16% of patients, with complete eradication achieved in all by the end of therapy.

The results indicate high efficacy and good tolerability of amoxicillin/clavulanic acid in patients with severe COPD and acute exacerbation. The drug proved to be a justified first-line therapeutic choice in accordance with GOLD 2025 recommendations. Study limitations include a small sample size and the absence of a control group, highlighting the need for further, larger-scale research.