# Chronic obstructive pulmonary disease (COPD) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Respiratory System 2026 · Egyptian National Drug Formulary - Respiratory 2026 (acetylcysteine monograph) · Egyptian National Drug Formulary - Respiratory 2026 (salbutamol monograph) · GOLD 2025 Report - Global Strategy for the Diagnosis, Management, and Prevention of COPD, chapter 5 (management of exacerbations) · Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) · GOLD 2025 Report - Global Strategy for the Diagnosis, Management, and Prevention of COPD, chapter 4 (management of exacerbations) · Seretide Accuhaler 50/500 SmPC section 4.1 Therapeutic indications and 4.2 Posology - COPD (eMC product 5504) · Spiriva ® 18 microgram, inhalation powder, hard capsule SmPC section 4.2 Posology and method of administration (eMC product 1693) · ATROVENT Inhaler CFC-Free 20 micrograms/actuation SmPC section 4.2 (eMC product 61) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (levofloxacin monograph, chronic obstructive pulmonary disease acute exacerbation) · Egyptian National Drug Formulary - Antimicrobial 2023 (moxifloxacin monograph, acute bacterial exacerbation of chronic bronchitis) · Chronic Obstructive Pulmonary Disease (COPD) - disease-level clinical article (copd-full.txt) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Respiratory 2026 (acetylcysteine monograph) - Egyptian National Drug Formulary - Respiratory 2026 (salbutamol monograph) - GOLD 2025 Report - Global Strategy for the Diagnosis, Management, and Prevention of COPD, chapter 5 (management of exacerbations) - Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) - GOLD 2025 Report - Global Strategy for the Diagnosis, Management, and Prevention of COPD, chapter 4 (management of exacerbations) - Seretide Accuhaler 50/500 SmPC section 4.1 Therapeutic indications and 4.2 Posology - COPD (eMC product 5504) - Spiriva ® 18 microgram, inhalation powder, hard capsule SmPC section 4.2 Posology and method of administration (eMC product 1693) - ATROVENT Inhaler CFC-Free 20 micrograms/actuation SmPC section 4.2 (eMC product 61) - Chronic Obstructive Pulmonary Disease (COPD) - disease-level clinical article (copd-clinical.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) - Egyptian National Drug Formulary - Antimicrobial 2023 (levofloxacin monograph, chronic obstructive pulmonary disease acute exacerbation) - Egyptian National Drug Formulary - Antimicrobial 2023 (moxifloxacin monograph, acute bacterial exacerbation of chronic bronchitis) - Chronic Obstructive Pulmonary Disease (COPD) - disease-level clinical article (copd-full.txt) ## Treatment metadata - Ipratropium bromide — 0.02 mg — oral.inhalation - Tiotropium bromide — 0.018 mg — oral.inhalation - Referral & safety-netting (no drug therapy) - Salmeterol + Fluticasone — 0.5 mg — oral.inhalation - Salbutamol — 0.1 mg — oral.inhalation - Prednisolone — 5 mg — oral.solid - Doxycycline — 100 mg — oral.solid - Azithromycin — 250 mg — oral.solid - Amoxicillin + Clavulanic acid — 625 mg — oral.solid - Acetylcysteine — 600 mg — oral.solid - Levofloxacin — 500 mg — oral.solid - Moxifloxacin — 400 mg — oral.solid - Azithromycin — 250 mg — oral.solid ## Complete treatment card ```text CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Sources: Egyptian National Drug Formulary - Respiratory System 2026 · Egyptian National Drug Formulary - Respiratory 2026 (acetylcysteine monograph) · Egyptian National Drug Formulary - Respiratory 2026 (salbutamol monograph) · GOLD 2025 Report - Global Strategy for the Diagnosis, Management, and Prevention of COPD, chapter 5 (management of exacerbations) · Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) · GOLD 2025 Report - Global Strategy for the Diagnosis, Management, and Prevention of COPD, chapter 4 (management of exacerbations) · Seretide Accuhaler 50/500 SmPC section 4.1 Therapeutic indications and 4.2 Posology - COPD (eMC product 5504) · Spiriva ® 18 microgram, inhalation powder, hard capsule SmPC section 4.2 Posology and method of administration (eMC product 1693) · ATROVENT Inhaler CFC-Free 20 micrograms/actuation SmPC section 4.2 (eMC product 61) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (levofloxacin monograph, chronic obstructive pulmonary disease acute exacerbation) · Egyptian National Drug Formulary - Antimicrobial 2023 (moxifloxacin monograph, acute bacterial exacerbation of chronic bronchitis) · Chronic Obstructive Pulmonary Disease (COPD) - disease-level clinical article (copd-full.txt) Review status: REVIEWED against Egyptian National Drug Formulary - Respiratory 2026 (acetylcysteine monograph), Egyptian National Drug Formulary - Respiratory 2026 (salbutamol monograph), GOLD 2025 Report - Global Strategy for the Diagnosis, Management, and Prevention of COPD, chapter 5 (management of exacerbations), Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph), GOLD 2025 Report - Global Strategy for the Diagnosis, Management, and Prevention of COPD, chapter 4 (management of exacerbations), Seretide Accuhaler 50/500 SmPC section 4.1 Therapeutic indications and 4.2 Posology - COPD (eMC product 5504), Spiriva ® 18 microgram, inhalation powder, hard capsule SmPC section 4.2 Posology and method of administration (eMC product 1693), ATROVENT Inhaler CFC-Free 20 micrograms/actuation SmPC section 4.2 (eMC product 61), Chronic Obstructive Pulmonary Disease (COPD) - disease-level clinical article (copd-clinical.txt), Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph), Egyptian National Drug Formulary - Antimicrobial 2023 (levofloxacin monograph, chronic obstructive pulmonary disease acute exacerbation), Egyptian National Drug Formulary - Antimicrobial 2023 (moxifloxacin monograph, acute bacterial exacerbation of chronic bronchitis), Chronic Obstructive Pulmonary Disease (COPD) - disease-level clinical article (copd- full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - Dyspnea starts with exertion and progresses to breathlessness at rest in severe disease [breathlessness] - Cough may be intermittent and is often the earliest symptom [cough] - Cough with sputum most days across at least 3 months in 2 straight years meets the chronic bronchitis definition [cough · sputum] - Sputum is mucoid at baseline and turns purulent during exacerbations [pus · sputum] - Wheezing and chest tightness occur in a subset, especially during exacerbations [chest pain · wheeze] - Fatigue, unintentional weight loss, and anorexia are systemic features of advanced disease [fatigue · poor appetite · weight loss] - Outside the lungs it brings skeletal muscle dysfunction, osteoporosis, cardiovascular disease, metabolic syndrome, low mood, anxiety and anaemia, each worsening the outlook on its own [anaemia · anxiety · low mood] - The range runs from a patient with no complaints at all whose spirometry is obstructed, through to respiratory failure needing a ventilator SIGNS - what you find (8) - Increased respiratory rate, accessory muscle use, and pursed-lip breathing [chest recession · tachypnoea] - Central cyanosis appears when resting oxygen saturation is critically low [cyanosis] - Barrel chest from an increased anteroposterior diameter due to hyperinflation - Hyperresonant chest percussion with reduced cardiac and hepatic dullness - Expiratory phase prolonged beyond an E:I ratio of 1:3, with wheeze or rhonchi [wheeze] - Hoover sign - paradoxical inward rib cage movement on inspiration - occurs in severe hyperinflation - Elevated jugular venous pressure and peripheral edema signal cor pulmonale [leg swelling] - Digital clubbing is not a typical COPD finding and should prompt a search for another cause [finger clubbing] TESTS (9) - Postbronchodilator FEV1/FVC ratio below 0.70 confirms persistent airflow limitation - A CAT score of 10 or more, or an mMRC of 1 or more, marks significant symptom burden - Blood eosinophil count is measured to guide inhaled corticosteroid decisions - Alpha-1 antitrypsin level below 11 micromol/L indicates significant deficiency - Arterial blood gas is indicated when FEV1 is under 50% predicted or SpO2 is under 95% on room air - Eosinophils at 300 cells/microL or more predict a favorable ICS response; under 100 makes benefit unlikely - Chest x-ray may show hyperinflation with flattened diaphragms and bullae - A 6-minute walk distance under 350 meters carries a significantly increased mortality risk - The fixed 0.70 ratio overdiagnoses older patients, and recent evidence supports reading it against the lower limit of normal instead Source StatPearls "Chronic Obstructive Pulmonary Disease (COPD)" - disease-level clinical article Status traced to the source above Rx: Short-acting reliever | Maintenance inhaler | Main treatment | Reliever | Exacerbation | Exacerbation - macrolide antibiotic | Exacerbation - beta-lactam antibiotic | Mucolytic | Exacerbation - escalation (GOLD 3 to 4, recent hospitalisation or antibiotics) | Long-term prevention of exacerbations SHORT-ACTING RELIEVER 1. IPRATROPIUM BROMIDE [1st line] Adult 20-40 mcg (1-2 puffs of 20 mcg/puff) QID - long-term Peds Not routinely indicated in children Source ATROVENT Inhaler CFC-Free 20 micrograms/actuation SmPC section 4.2 (eMC product 61) Why Short-acting anticholinergic bronchodilator that blocks muscarinic receptors in airway smooth muscle, relieving bronchospasm and improving airflow in COPD. Caution Caution in glaucoma and urinary retention. Dry mouth is a common side effect. Avoid spraying directly into eyes. Egypt ASMATROPIM 250MCG/ML 20 NEBULIZER VIAL SOLN. GLOBAL ADVANCED PHARMACEUTI... 70.00 EGP -> ? strength differs IPRATROPIUM VIATRIS 0.25MG/ML (CHILDREN) 10 UNIT DOSE VIAL LABORATOIRE U... 74.00 EGP -> ? strength differs IPRATROPIUM VIATRIS 0.5MG/2ML (ADULTS) 10 UNIT DOSE VIAL LABORATOIRE UNI... 80.00 EGP -> ? strength differs LUNGOTROPIUM 250MCG/1ML 20 UNIT DOSE VIAL NEBULIZER SOLN EVA PHARMA 152.00 EGP -> ? strength differs ASMATROPIM 500MCG/2ML 20 NEBULIZER VIAL SOLN. GLOBAL ADVANCED PHARMACEUT... 164.00 EGP -> ? strength differs LUNGOTROPIUM 500MCG/2ML 20 UNIT DOSE VIAL NEBULIZER SOLN EVA PHARMA 164.00 EGP -> ? strength differs ATROVENT 250MCG/2ML 20 UNIT DOSE INH. VIAL. BOEHRINGER INGELHEIM 286.00 EGP -> ? strength differs ATROVENT 500 MCG/2ML 20 UNIT DOSE INH. VIAL. BOEHRINGER INGELHEIM 286.00 EGP -> ? strength differs MAINTENANCE INHALER - choose one 2. TIOTROPIUM BROMIDE [1st line] Adult 18 mcg per capsule (1 capsule inhaled once daily via DPI device) - long-term Peds Not indicated in children Source Spiriva ® 18 microgram, inhalation powder, hard capsule SmPC section 4.2 Posology and method of administration (eMC product 1693) Why Long-acting anticholinergic bronchodilator used for maintenance therapy in COPD, giving sustained blockade of airway muscarinic receptors for smoother, longer-lasting symptom control than the short-acting agent. Caution Do not swallow capsules - inhale via device. Caution in moderate-to-severe renal impairment. Avoid contact with eyes. Egypt CIPLA-TROPIUM 18 MCG MULTIHALER DRY POWDER FOR ORAL INHALATION CIPLA LTD... 126.00 EGP 3. SALMETEROL + FLUTICASONE [2nd line] Adult 1 inhalation (50/500 mcg per dose) twice daily - long-term Peds Not indicated for COPD in children Source Seretide Accuhaler 50/500 SmPC section 4.1 Therapeutic indications and 4.2 Posology - COPD (eMC product 5504) Why Combination long-acting beta agonist and inhaled corticosteroid; the bronchodilator component relaxes airway smooth muscle while the steroid component reduces airway inflammation, used together in more severe or exacerbation-prone COPD needing combined bronchodilation and anti-inflammatory control. Caution COPD is the 50/500 strength, not 50/250. The SmPC licenses 50 micrograms salmeterol with 500 micrograms fluticasone twice daily for COPD; 50/250 is an asthma strength and delivers half the licensed steroid dose here. Rinse mouth after inhalation. Reserve for patients with frequent exacerbations. There is an increased risk of pneumonia in COPD patients on ICS. Egypt SEROFLO 100/50MCG PD. FOR INH. 30 BLISTERS CIPLA LTD. - INDIA > STAR INT... 52.50 EGP -> ? strength differs SEROFLO 250/50MCG PD. FOR INH. 30 BLISTERS CIPLA LTD. - INDIA > STAR INT... 63.00 EGP -> ? strength differs SEROFLO 500/50MCG PD. FOR INH. 30 BLISTERS CIPLA LTD. - INDIA > STAR INT... 77.00 EGP -> ? strength differs METRICASON 125/25 MCG 120 METERED ACTUATIONS MDI PHARMA 121.00 EGP -> ? strength differs SERETIDE EVOHALER 50/25MCG 120 METERED ACTUATIONS GLAXO SMITHKLINE > MOD... 198.00 EGP -> ? strength differs SERETIDE DISKUS 100/50MCG 60 DOSES GLAXO SMITHKLINE > MODERN PHARMA 244.00 EGP -> ? strength differs SERETIDE DISKUS 250/50MCG 60 DOSES GLAXO SMITHKLINE > MODERN PHARMA 335.00 EGP -> ? strength differs SERETIDE DISKUS 500/50MCG 60 DOSES GLAXO SMITHKLINE > MODERN PHARMA 411.00 EGP -> ? strength differs MAIN TREATMENT 4. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Chronic Obstructive Pulmonary Disease (COPD) - disease-level clinical article (copd- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Warning signs of impending respiratory failure during an exacerbation require urgent escalation. RELIEVER - give alongside 5. SALBUTAMOL [add-on - not a substitute] Adult 100-200 mcg (1-2 puffs of 100 mcg/puff) as needed, up to 4 times a day; maximum 8 puffs in 24 hours and not more often than every 4 hours - as-needed, long-term Peds COPD is not a paediatric condition. Salbutamol is dosed by puffs, not by weight, in any case. Source Egyptian National Drug Formulary - Respiratory 2026 (salbutamol monograph) Why GOLD says a rescue short-acting bronchodilator goes to every COPD patient; maintenance inhalers do not fill that role. The patient who is breathless walking to the mosque has nothing to reach for without one. Caution This is the rescue inhaler. It is given in addition to the maintenance inhaler above, never instead of it. Needing it more than usual, or more than 8 puffs a day, means the disease is not controlled or an exacerbation is starting - review, do not just repeat the prescription. Tremor and palpitations are dose-related and common at 2 puffs. Use a spacer if the technique is poor - which it often is in an elderly patient with arthritic hands. Egypt AEROLIN 100MCG/DOSE INHALER EIPICO > 3M H... 7.30 EGP BUTALIN 100MCG/ACTUATION 200 DOSES JULPHAR 12.00 EGP VENTAL INHALER 100 MCG/DOSE 200 DOSES ARAB DRUG COMPANY (ADCO) 72.00 EGP VIASALMOL 100MCG 200 ACTUATION INHALER MDI PHARMA 72.00 EGP VENTOLIN EVOHALER 100MCG/ACTUATION INHALER GLAXO SMITHKLINE 86.00 EGP OPICHESTAL SYRUP 120ML EL-OBOUR 2.00 EGP -> ? strength differs, ? different route - not oral.inhalation SALBUTAMOL 2MG/5ML SYRUP 120ML SEDICO 3.50 EGP -> ? strength differs, ? different route - not oral.inhalation EXACERBATION - give alongside 6. PREDNISOLONE [add-on - not a substitute] Adult 40 mg once daily in the morning x 5 days, then stop - no taper Peds COPD is not a paediatric condition. Source GOLD 2025 Report - Global Strategy for the Diagnosis, Management, and Prevention of COPD, chapter 4 (management of exacerbations) Why The exacerbation is what brings the COPD patient to the clinic, and the prescription for it is a steroid and sometimes an antibiotic on top of the inhalers. Neither was in this condition. Caution For the exacerbation only - 5 days and stop. GOLD says duration should not normally be more than 5 days, and longer courses are associated with more pneumonia and more deaths. No taper is needed after 5 days. Raises blood glucose sharply - warn the diabetic patient and expect to need extra cover. Do not stop the inhalers while the steroid is running. Repeated courses carry the pneumonia, sepsis and fracture risk of chronic steroid use even when each course is short. GOLD writes 40 mg prednisone-equivalent. Prednisolone is what Egypt sells and the two are equivalent milligram for milligram, but the guideline's word is prednisone. Egypt HOSTACORTIN H 5MG 30 TAB. SANOFI 12.00 EGP (0.40/unit) PREDNISOLONE 5 MG 20 TABS. ARAB DRUG COM... 24.00 EGP (1.20/unit) PREDILONE 5MG 10 TAB. (25 STRIPS PACK) KAHIRA 250.00 EGP (25.00/unit) EPICOPRED 5 MG 30 ORODISPERSIBLE TABS. EIPICO 69.00 EGP PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS. EVA PHARMA 79.50 EGP DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS. ANDALOUS PHARMA 84.00 EGP SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS. SANOFI WINTHROP > SANOFI 84.00 EGP ACETASEE 1% EYE DROPS (SUSP.) 5 ML RAMEDA 7.50 EGP -> ? strength differs, ? different route - not oral solid PREDNIS 5MG/5ML SYRUP 100 ML PHAROPHARMA 9.50 EGP -> ? strength differs, ? different route - not oral solid 7. DOXYCYCLINE [add-on - not a substitute] Adult 100 mg twice daily on day 1, then 100 mg once or twice daily x 5 days Peds COPD is not a paediatric condition. Source Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) Why The Egyptian Essential Medicine List names exacerbations of COPD as a doxycycline indication, and it is an AWaRe Access antibiotic - the group to reach for first. GOLD names tetracycline among the empirical choices and caps outpatient treatment at 5 days. Caution Only when the sputum has turned purulent. GOLD requires increased purulence to be one of the symptoms before an antibiotic is justified - green sputum, not just more of it. 5 days, not 10. Longer courses give no extra benefit and select resistance. Swallow upright with a full glass of water and not at bedtime - the capsule ulcerates the oesophagus if it lodges. Photosensitivity matters in Egyptian sun; advise cover for the 5 days. Separate from antacids, iron and dairy by 2 hours. Not in pregnancy, and not under 8 years. Egypt FARCODOXIN 100MG 10 CAPS. PHARCO 11.00 EGP (1.10/unit) DOXY M.R.100 MG 10 CAPS. ADWIA 12.00 EGP (1.20/unit) GRANUDOXY 100MG 10 F.C. TAB. GLOBAL NAPI P... 12.00 EGP (1.20/unit) DOXYDOX 100 MG 10 CAPS. EIPICO 23.00 EGP (2.30/unit) DOXYMYCIN 100 MG 10 CAPS. EL NILE. 30.00 EGP (3.00/unit) TABOCINE 100MG 10 CAPS. TABUK PHARMAC... 46.00 EGP (4.60/unit) VIBRAMYCIN 100MG 10 CAPS. PFIZER 65.00 EGP (6.50/unit) EXACERBATION - MACROLIDE ANTIBIOTIC - give alongside 8. AZITHROMYCIN [add-on - not a substitute] Adult Oral: 500 mg in a single loading dose on day 1, followed by 250 mg once daily on days 2 to 5 or 500 mg once daily for 3 days x 3 to 5 days Peds 5-6 mg/kg/day [child max 250 mg] (Children (general dosing): Oral: 10 to 12 mg/kg once on day 1 (maximum 500 mg/dose), then 5 to 6 mg/kg once daily (maximum 250 mg/dose).) 3kg -> 15-18 mg/day 4kg -> 20-24 mg/day 5kg -> 25-30 mg/day 6kg -> 30-36 mg/day 7kg -> 35-42 mg/day 8kg -> 40-48 mg/day 9kg -> 45-54 mg/day 10kg -> 50-60 mg/day 11kg -> 55-66 mg/day 12kg -> 60-72 mg/day 13kg -> 65-78 mg/day 14kg -> 70-84 mg/day 15kg -> 75-90 mg/day 16kg -> 80-96 mg/day 17kg -> 85-102 mg/day 18kg -> 90-108 mg/day 19kg -> 95-114 mg/day 20kg -> 100-120 mg/day 21kg -> 105-126 mg/day 22kg -> 110-132 mg/day 23kg -> 115-138 mg/day 24kg -> 120-144 mg/day 25kg -> 125-150 mg/day 26kg -> 130-156 mg/day 27kg -> 135-162 mg/day 28kg -> 140-168 mg/day 29kg -> 145-174 mg/day 30kg -> 150-180 mg/day 31kg -> 155-186 mg/day 32kg -> 160-192 mg/day 33kg -> 165-198 mg/day 34kg -> 170-204 mg/day 35kg -> 175-210 mg/day 36kg -> 180-216 mg/day 37kg -> 185-222 mg/day 38kg -> 190-228 mg/day 39kg -> 195-234 mg/day 40kg -> 200-240 mg/day 41kg -> 205-246 mg/day 42kg -> 210-250 mg/day (upper capped) 43kg -> 215-250 mg/day (upper capped) 44kg -> 220-250 mg/day (upper capped) 45kg -> 225-250 mg/day (upper capped) 46kg -> 230-250 mg/day (upper capped) 47kg -> 235-250 mg/day (upper capped) 48kg -> 240-250 mg/day (upper capped) 49kg -> 245-250 mg/day (upper capped) 50kg -> 250 mg/day (capped) AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Alternative first-line macrolide antibiotic for acute bacterial exacerbations of COPD. Caution Hypersensitivity to azithromycin, erythromycin, or other macrolides. Azithromycin is predominantly hepatically eliminated; use with caution in hepatic impairment. Risk of QT prolongation and altered cardiac conduction. Egypt AZATRIBACT 250MG 6 CAPS. RIVA PHARMA S... 15.00 EGP (2.50/unit) AZOMYCIN 250MG 6 CAPS. PHARCO 25.20 EGP (4.20/unit) AZITHROMIN 250MG 6 CAPS. EL NILE. 31.50 EGP (5.25/unit) AZALIDE 250MG 6 CAPS. UP PHARMA 49.50 EGP (8.25/unit) NEOZOLID 250 MG 6 TABS. BORG 53.00 EGP (8.83/unit) AZI-ONCE 250MG 6 CAPS. JAMJOOM PHARM... 54.00 EGP (9.00/unit) ZITHROMAX 250MG 6 CAPS. PFIZER 79.00 EGP (13.17/unit) DISTABCIN 250 MG 6 DISPERSIBLE TABS. EGPI 43.50 EGP ZITHRODOSE 100MG/5ML SUSP. 15ML EL-OBOUR > AV... 12.00 EGP -> ? strength differs, ? different route - not oral solid ZITHROPHATE 200MG/5ML SUSP. 15ML ORGANO PHARMA... 12.75 EGP -> ? strength differs, ? different route - not oral solid EXACERBATION - BETA-LACTAM ANTIBIOTIC - give alongside 9. AMOXICILLIN + CLAVULANIC ACID [add-on - not a substitute] Adult 500 mg every 8 to 12 hours, or 875 mg every 12 hours x 5 to 7 days Peds Not applicable - COPD is an adult disease. Source Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) Why The disease article makes co-amoxiclav one of three first-line antibiotics for an exacerbation with purulent sputum, alongside the doxycycline and azithromycin the card already carried; it is the beta-lactam option, which the card had none of. The ENDF's oral indication list does not name COPD, but its IV list names chronic bronchitis (acute exacerbation) and its oral dosing range is what is written here. Caution Hypersensitivity to amoxicillin, clavulanic acid, other beta-lactam antibacterial drugs (eg, penicillins, cephalosporins), or any component of the formulation; history of cholestatic jaundice or hepatic dysfunction with amoxicillin/clavulanate potassium therapy. Antibiotics are indicated when sputum purulence is accompanied by increased dyspnea or volume - not for every exacerbation. Egypt AUJED 625 MG 12 F.C. TAB. SIGMA TEC > J... 19.20 EGP (1.60/unit) E-MOXCLAV 625MG 10 TAB. EIPICO 30.00 EGP (3.00/unit) DEXICLAVE 625 MG 12 F.C. TABS. RAMEDA > NOVE... 37.50 EGP (3.12/unit) MAGNABIOTIC 625MG 8 TAB. SEDICO 37.00 EGP (4.62/unit) CLAVIMOX 625 MG 12 F.C.TABS. PHARCO 107.00 EGP (8.92/unit) CURAM 625MG 12 F.C.TAB. SANDOZ > NOVA... 108.00 EGP (9.00/unit) AUGMENTIN 625 MG 10 F.C.TABS. MUP > SMITHKL... 117.00 EGP (11.70/unit) CLAVOCILLIN 625 MG 10 DISPERSIBLE TABS. RAMEDA > ORGANOPHARMA 31.50 EGP LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral solid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral solid MUCOLYTIC - give alongside 10. ACETYLCYSTEINE [add-on - not a substitute] Adult 600 mg once daily, or 200 mg three times daily, by mouth; abundant fluid intake supports the mucolytic effect - The formulary leaves duration to the prescriber - assess symptomatic benefit at 4 weeks and stop if there is none Peds Over 12 years: 200 mg three times daily 14 years and over: 600 mg once daily, or 200 mg three times daily. Maximum 600 mg a day. (Adolescents over 12 years: 200 mg three times daily. Adolescents 14 years and over: 600 mg once daily or 200 mg three times daily. Maximum 600 mg/day. Safety and efficacy are not established under 12 years. COPD is not a paediatric condition in any case.) Source Egyptian National Drug Formulary - Respiratory 2026 (acetylcysteine monograph) Why 29 live products, mostly the 600 mg effervescent tablet. The formulary's oral indication is a mucolytic adjuvant in respiratory disorders with thick viscous mucus hypersecretion, which is the chronic productive cough that this condition's three inhalers do nothing for. Caution An add-on for chronic productive cough, not a treatment for airflow obstruction - it does not replace or reduce the need for the inhalers already listed. Stop if there is no symptomatic benefit after a reasonable trial; a mucolytic that is not helping is just cost. May provoke bronchospasm - caution in a patient with an asthma component; have the salbutamol to hand at the first dose. The intravenous product is the paracetamol overdose antidote at completely different doses - do not confuse the two. Encourage generous fluid intake, which the formulary states supports the mucolytic effect. Effervescent tablets carry a significant sodium load - relevant in heart failure and hypertension. Egypt ACETOLYTIC 600 MG 10 CAPS. AVERROES PHARMA 71.00 EGP (7.10/unit) ACENEWRAX 600 MG 10 SACHETS JEDCO INT. CO... 44.00 EGP ROTACYSTEINE 600 MG 10 SACHETS ROTABIOGEN 60.00 EGP ACETYLCYSTDAR 600 MG 12 EFF. TABS. CID > PHARMADAR 70.00 EGP WINDY 600 MG 10 SACHET PHARCO 70.00 EGP FLUBRONK 600 MG 10 EFF. TABS. EIPICO 73.00 EGP ROTACYSTEINE 600 MG 20 SACHETS ATCO PHARMA >... 120.00 EGP FLUIMUCIL 600MG 10 EFF. TABS. ZAMBON > PHAR... 135.00 EGP ACESOLV 2% SYRUP 60ML EL-OBOUR > SP... 8.00 EGP -> ? strength differs, ? different route - not oral solid SOLVIMYST 100MG/5ML SYRUP 120ML MASH PREMIERE 44.00 EGP -> ? strength differs, ? different route - not oral solid EXACERBATION - ESCALATION (GOLD 3 TO 4, RECENT HOSPITALISATION OR ANTIBIOTICS) - give alongside 11. LEVOFLOXACIN [add-on - not a substitute] Adult 500 to 750 mg once daily by mouth or intravenously Peds ENDF: in pediatric patients, fluoroquinolones are not routinely first-line therapy. COPD is in any case an adult disease. AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Choice Alternatives. Levofloxacin is named first by the article, and the ENDF's levofloxacin indication list names chronic obstructive pulmonary disease acute exacerbation by name where moxifloxacin's names chronic bronchitis; levofloxacin also has an oral and an IV route in the same monograph. Source Egyptian National Drug Formulary - Antimicrobial 2023 (levofloxacin monograph, chronic obstructive pulmonary disease acute exacerbation) Why The article escalates to a respiratory fluoroquinolone, naming levofloxacin first, for GOLD 3 to 4 disease, recent hospitalisation or recent antibiotic exposure - it puts this under inpatient management of a moderate to severe exacerbation. The ENDF names that indication in the monograph's own list. Caution Limitations of use: Because fluoroquinolones have been associated with disabling and potentially irreversible serious adverse reactions (eg, tendinopathy and tendon rupture, peripheral neuropathy, CNS effects), reserve levofloxacin for use in patients who have no alternative treatment options for acute exacerbation of chronic bronchitis, acute bacterial sinusitis, and uncomplicated urinary tract infections. Dose is reduced in renal impairment - the ENDF gives a full CrCl table for the 250, 500 and 750 mg regimens. Egypt FLOXABACT 500 MG 10 F.C.TABS.(NOW LEVOFLOXACIN-EVA) EVA PHARMA 40.00 EGP (4.00/unit) LEVOMAGICTAM 500 MG 5 F.C.TABS. MEDIZEN PHARM... 27.00 EGP (5.40/unit) EXACINOP 500 MG 10 F.C.TABS. EL-OBOUR > MA... 65.00 EGP (6.50/unit) ROYAFLOXACIN 500 MG 10 F.C.TABS. MEDIZEN PHARM... 92.00 EGP (9.20/unit) TAVIXINOR 500 MG 5 F.C. TABS. MASH PREMIERE... 64.50 EGP (12.90/unit) BIOWORLD 500 MG 10 F.C. TABS. EGPI > BIOWORLD 133.00 EGP (13.30/unit) TAVANIC 500 MG 5 F.C.TABS. SANOFI 192.00 EGP (38.40/unit) ALFASPECT 500 MG 5 S.F.C.TABS. SPIMACO PHARM... 70.00 EGP 12. MOXIFLOXACIN [add-on - not a substitute] Adult 400 mg once daily by mouth or intravenously Peds ENDF: in pediatric patients, fluoroquinolones are not routinely first-line therapy, and limited dosing data are available. COPD is in any case an adult disease. AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 (moxifloxacin monograph, acute bacterial exacerbation of chronic bronchitis) Why The article's other named respiratory fluoroquinolone for the same escalation. No renal dose adjustment is needed, which is the practical reason to reach for it over levofloxacin. Caution Limitations of use: Because fluoroquinolones have been associated with disabling and potentially irreversible serious adverse reactions (eg, tendinopathy and tendon rupture, peripheral neuropathy, CNS effects), reserve use of moxifloxacin for acute exacerbation of chronic bronchitis or acute sinusitis for patients who have no alternative treatment options. Hypersensitivity to moxifloxacin, other quinolone antibiotics, or any component of the formulation Avoid with other QT-prolonging agents; the ENDF asks for an ECG in patients with liver cirrhosis. Egypt MOXILABACT 400 MG 5 F.C. TABS. KAHIRA 30.60 EGP (6.12/unit) GASTAMOXACINE 400MG 7 F.C. TAB. MEDIZEN PHARM... 45.00 EGP (6.43/unit) MERAMERIX 400MG 5 F.C.TAB. PHARMED HEALT... 40.50 EGP (8.10/unit) IDELOX 400MG 10 F.C. TAB. RAMEDA 116.00 EGP (11.60/unit) PRIMOXIZAR 400 MG 5 F.C. TAB. PHARMA CURE P... 80.00 EGP (16.00/unit) MOXIFLOX 400 MG 10 F.C.TABS. EVA PHARMA 180.00 EGP (18.00/unit) MOXAVIDEX 400 MG 10 F.C.TABS. FUTURE PHARMA... 184.00 EGP (18.40/unit) MOXAVIDEX 400 MG 5 F.C.TABS. FUTURE PHARMA... 92.00 EGP (18.40/unit) MOXIFLOXACIN-EL NILE 400MG/250ML SOL. FOR INF. EL NILE. 80.50 EGP -> ? strength differs, ? different route - not oral solid MOXITRIX 400MG/250ML SOL. FOR INF. ARAB CO. FOR MEDICAL PRODUCTS > SPIMA... 86.00 EGP -> ? strength differs, ? different route - not oral solid LONG-TERM PREVENTION OF EXACERBATIONS - give alongside 13. AZITHROMYCIN [add-on - not a substitute] Adult 250 mg once daily, or 500 mg three times weekly, long term Peds Not applicable - COPD is an adult disease. AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Chronic Obstructive Pulmonary Disease (COPD) - disease-level clinical article (copd- full.txt) Why A different prescription from the card's other azithromycin row, which is the 3 to 5 day course for an acute exacerbation. This one is taken continuously to make exacerbations less frequent in patients having two or more a year despite optimised inhaled therapy. The ENDF doses azithromycin for the acute exacerbation only, so the maintenance figure comes from the disease article, which states drug and dose in one sentence. Caution Four baseline checks are mandatory before the first dose: an ECG - a QTc beyond 450 ms weighs against treatment, as a relative contraindication - a hearing test, a sputum culture to rule out non-tuberculous mycobacterial infection, and liver function tests. Hearing is then retested once a year for as long as treatment continues. Do not put a current smoker on maintenance azithromycin: cardiovascular risk runs higher in that group, and the benefit has not been demonstrated. The same article also describes the candidates as people who have smoked in the past or who smoke now - the two statements conflict, and the source is reported as it stands; treat current smoking as the stronger signal against starting. Hypersensitivity to azithromycin, erythromycin, other macrolide (eg, azalide or ketolide) antibiotics, or any component of the formulation. Egypt AZATRIBACT 250MG 6 CAPS. RIVA PHARMA S... 15.00 EGP (2.50/unit) AZOMYCIN 250MG 6 CAPS. PHARCO 25.20 EGP (4.20/unit) AZITHROMIN 250MG 6 CAPS. EL NILE. 31.50 EGP (5.25/unit) AZALIDE 250MG 6 CAPS. UP PHARMA 49.50 EGP (8.25/unit) NEOZOLID 250 MG 6 TABS. BORG 53.00 EGP (8.83/unit) AZI-ONCE 250MG 6 CAPS. JAMJOOM PHARM... 54.00 EGP (9.00/unit) ZITHROMAX 250MG 6 CAPS. PFIZER 79.00 EGP (13.17/unit) DISTABCIN 250 MG 6 DISPERSIBLE TABS. EGPI 43.50 EGP ZITHRODOSE 100MG/5ML SUSP. 15ML EL-OBOUR > AV... 12.00 EGP -> ? strength differs, ? different route - not oral solid ZITHROPHATE 200MG/5ML SUSP. 15ML ORGANO PHARMA... 12.75 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)