INTRODUCTION- COPD exacerbations are serious events that are often caused by bacterial infections, requiring effective antibiotic treatment. It is essential to have a clear understanding of the bacterial pathogens responsible for these exacerbations and their sensitivity patterns to optimize therapeutic approaches. METHODOLOGY: For this study, a total of 90 patients with COPD who were currently experiencing acute exacerbations were enrolled. Detailed clinical assessments were conducted and sputum samples were collected before administering antibiotics. The analysis of sputum samples involved the utilization of Gram's stain, culture, and sensitivity testing. RESULTS: Out of the 90 cases examined, the majority (81%) were males. The most prevalent clinical symptoms observed were cough with expectoration, exertional dyspnea, and mucopurulent sputum production. The majority of isolates were gram-negative bacteria, with Pseudomonas aeruginosa being the most common at 28%, followed by Klebsiella pneumoniae at 16%. Based on the sensitivity pattern analysis, it was found that the combination of Ciprofloxacin and gentamicin was the most effective empirical antibiotic combination, with a success rate of 79.55%. In terms of single antibiotics, piperacillin+tazobactam showed the highest sensitivity at 68.18%, followed by Amoxicillin and clavulanic acid at 54.55%. CONCLUSION: Our study sheds light on the prevalence of Gram-negative bacteria in acute exacerbations of COPD and offers valuable information on antibiotic sensitivity patterns. These findings highlight the significance of customizing antibiotic therapy according to local resistance patterns in order to enhance treatment outcomes in COPD exacerbations.