09 July 2018

Antibiotics should be restricted for COPD

Healthcare professionals should consider the risk of antimicrobial resistance when deciding whether antibiotics are needed for treating or preventing a flare up of symptoms of chronic obstructive pulmonary disease (COPD).

  

These draft recommendations come as NICE publishes draft antimicrobial prescribing guidance and a separate update to its 2010 clinical guideline on diagnosing and managing COPD in over 16s.

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, such as the number and severity of symptoms.

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.

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.”

The other draft clinical guideline update, published today, 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, 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 needs to be balanced against the potential for more antibiotic resistance.”

COPD is a broad term that covers several lung conditions that make breathing difficult. Some people experience flare-ups where their symptoms are particularly severe, these are called exacerbations.

COPD affects approximately 3 million people in the UK, 2 million of which are undiagnosed.

The evidence shows that there are limited benefits of using antibiotics for managing acute exacerbations of COPD.

Professor Mark Baker, director of the centre for guidelines at NICE

Prophylactic antibiotics should only be offered to carefully selected patients and other treatment options, particularly stopping smoking, should be considered first.

Dr Andrew Molyneux, Chair of the COPD update committee