Chronic obstructive pulmonary disease (COPD) is one of the most frequent respiratory adult infections in the developed world and in the United States alone, around 16 million people are diagnosed annually. It is the fourth leading cause of death and its annual mortality has been predicted to increase from 2.25 million deaths in 1990 to 4.5 million deaths in 2020. Acute exacerbations of COPD (AECOPD) can cause respiratory failure which is one of the main causes of death in such patients.
Because of the potential seriousness of the infection and its major financial implications, such as the costs associated with hospitalization and days lost from work, physicians need to have a rapid treatment which is both safe and effective.
Over the last twenty years, the fluoroquinolones have established themselves as very powerful antibiotics with a wide spectrum of activity. Their antibacterial activity is concentration-dependent, meaning that the higher the dose, the more rapid and efficient is the bacterial killing. They also exhibit excellent respiratory tract penetration. In particular, levofloxacin has been shown to be very safe and effective with excellent pharmacodynamic and pharmacokinetic properties. Its relatively low incidence of side effects means that it can be given as a daily dose of 750 mg producing a high cure rate in a relatively short period, typically 5 days. Its safety profile is so good that, if the clinical situation warrants it, 1,000 mg levofloxacin daily is possible. Using high doses for short periods limits the total exposure to drug and potentially, may help to combat the emergence of bacterial resistance.

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