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Objective: to evaluate the adherence to clinical guidelines for appropriate use of antibiotics in patients with COPD exacerbations, and to explore the association between this prescription and clinical outcomes. Methods: a retrospective cohort study of patients admitted with COPD diagnosis between January 1, 2010 and December 31, 2012. The following variables were recorded: socio-demographic characteristics, spirometric classification, oxygen use at home, number of exacerbations in the previous year, recent antibiotic use, previous need for mechanical ventilation, previous vaccination, comorbidities, clinical presentation, antibiotic use indications and vital status. Results: 419 patients were included, 59 % (n = 247) were women, median age was 76 years, 62 % had clinical diagnosis, 75 % had an established outpatient management and 11 % had been previously treated for exacerbation of COPD. Out of 170 patients with any indication for using antibiotics the latter were prescribed in 140 (82 %), while 118 (47 %) of 249 patients with no criterion for their use received them. Mortality rate was higher in the group with indications for antibiotics. Conclusions: an acceptable level of adherence to guidelines was observed in the use of antibiotics when indicated. However, the percentage of patients in whom antibiotics were unnecessarily prescribed seems to be larger than expected and demands further investigation.