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Antibiotics should be restricted for COPD, says NICE

Antimicrobial resistance to be factored into decisions

Jo Carlowe

Monday, 09 July 2018

Healthcare professionals should consider antimicrobial resistance when deciding whether antibiotics are needed for treating symptoms of chronic obstructive pulmonary disease (COPD).

This is the ruling made by the National Institute for Health and Care Excellence (NICE) in draft antimicrobial prescribing guidance published today.

In a separate clinical guideline update, also published today, NICE has made draft recommendations on when antibiotics should be used to prevent flare ups happening in the first place.

The draft antimicrobial guidance recommends that antibiotics should be offered to people who have a severe flare up of symptoms, also known as a severe acute exacerbation.

However other factors should be taken into account when considering the use of antibiotics for treating an acute exacerbation that is not severe. These include the number and severity of symptoms, previous exacerbation history, the risk of developing complications, and the risk of antimicrobial resistance with repeated courses of antibiotics.

The guidance notes that acute exacerbations of COPD can be caused by a range of factors including viral infections and smoking. Only around half are caused by bacterial infections, so many exacerbations will not respond to antibiotics.

Commenting, Professor Mark Baker, director of the centre for guidelines at NICE said: “The evidence shows that there are limited benefits of using antibiotics for managing acute exacerbations of COPD and that it is important other options are taken into account before antibiotics are prescribed.

“The new guideline will help healthcare professionals make responsible prescribing decisions to not only help people manage their condition but also reduce the risk of resistant infections.”

Where the prescription of antibiotics is appropriate the guideline includes recommendations to help doctors choose the type, dosage and course length of treatment.

If antibiotics aren’t prescribed it is recommended that people are given advice about the circumstances that should prompt them to seek further medical help without delay.

The second set of draft recommendations published today are included in an update to the 2010 clinical guideline on diagnosing and managing COPD in over 16s.

The draft recommendations include advice on antibiotic prophylaxis. It recommends that antibiotics used in this way should only be offered to people who are most likely to benefit from them.

Dr Andrew Molyneux, chair of the COPD update committee, says: “COPD is a common and life-threatening illness, causing 115,000 admissions to hospital every year. For some people who have frequent exacerbations, prophylactic antibiotics can help to reduce the frequency of exacerbations and admissions to hospital. However, the benefits of prophylactic antibiotics need to be balanced against the potential for more antibiotic resistance.

“With this in mind prophylactic antibiotics should only be offered to carefully selected patients and other treatment options, particularly stopping smoking, should be considered first.”

The COPD antimicrobial prescribing guideline is open for consultation until 31 July 2018. The draft clinical guideline update is open for consultation until 8 August 2018.

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