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GPs should consider restricting antibiotics for COPD

NICE says antimicrobial resistance is a risk issue

Adrian O'Dowd

Friday, 07 December 2018

GPs and other healthcare professionals should consider the risk of antimicrobial resistance in their patients before deciding to prescribe antibiotics to treat or preventing a flare up of symptoms of chronic obstructive pulmonary disease (COPD).

That is the final advice from National Institute for Health and Care Excellence (NICE) in its newly published antimicrobial prescribing guidance and a separate update to its 2010 clinical guideline on diagnosing and managing COPD in over 16s.

COPD is estimated to affect approximately three million people in the UK, two million cases of which are undiagnosed.

The antimicrobial guidance recommends 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, said the watchdog, when considering the use of antibiotics for treating an acute exacerbation that is not severe, such as the number and severity of symptoms.

The guidance authors said that acute exacerbations of COPD could be caused by a range of factors including viral infections and smoking. However, only around half were caused by bacterial infections, so many exacerbations would not respond to antibiotics.

Paul Chrisp, director of the centre for guidelines at NICE, said: “Evidence shows that there are limited benefits of using antibiotics for managing acute exacerbations of COPD and that it is important to take other options into account before antibiotics are prescribed.

“These recommendations will help healthcare professionals to make responsible prescribing decisions, which will not only help people manage their condition but also reduce the risk of antimicrobial resistance.”

The other clinical guideline update states when to use antibiotics to prevent exacerbations happening in the first place (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, said: “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 needs to be balanced against the potential for more antibiotic resistance.”

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