A 60-year-old man with COPD presenting with an acute bacterial exacerbation is penicillin-allergic; which first-line antibiotic is most appropriate?

Azithromycin

Doxycycline

In COPD acute bacterial exacerbations, antibiotics are chosen to reliably cover the common respiratory pathogens (Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae) while avoiding beta-lactams in penicillin-allergic patients. Doxycycline fits this need because it has good activity against these typical pathogens and also covers atypicals, with excellent lung penetration and a favorable safety profile. It provides effective outpatient first-line therapy without using a beta-lactam, which is important for someone with a penicillin allergy. Other options either rely on beta-lactams (not suitable here) or involve broader-spectrum agents with more potential for resistance or adverse effects, making doxycycline the most appropriate first-line choice in this scenario.

Amoxicillin

Levofloxacin

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