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January 2019

Reserve preventive antibiotics for COPD patients who will benefit most

Healthcare professionals should consider the risk of antimicrobial resistance when deciding whether antibiotics are needed for treating or preventing COPD exacerbations, says NICE.

The recommendation follows publication of antimicrobial prescribing guidance (APG) and a separate update to its 2010 clinical guideline on diagnosing and managing COPD in over 16s.

The antimicrobial guidance recommends that antibiotics should be offered to people who have 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.

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 updated COPD clinical guideline, published last month, spells out when to use antibiotics to prevent exacerbations happening in the first place. It recommends that antibiotic prophylaxis should only be offered to people who are most likely to benefit.

Dr Andrew Molyneux, chair of the COPD update committee, said: ‘COPD causes 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.’

You can read a Practice Nurse ‘Guidelines in a Nutshell’ summary of the latest COPD guideline here