The National Institute for Health and Care Excellence has urged caution among prescribers over the use of antibiotics for patients with chronic obstructive pulmonary disease.
Clinicians should consider the risk of antimicrobial resistance when deciding whether antibiotics are needed for treating a COPD flare up, said NICE in draft prescribing guidance published today.
“There are limited benefits of using antibiotics for managing acute exacerbations of COPD”
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 patients who have a severe flare up of symptoms – also known as a severe acute exacerbation.
However, NICE said other factors should be taken into account when considering the use of antibiotics for treating an acute exacerbation that was not severe.
These included the number and severity of symptoms, previous exacerbation history, the risk of developing complications, and risk of antimicrobial resistance with repeated courses of antibiotics.
The draft NICE 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, according to the institute.
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,” she said.
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 are not prescribed, NICE recommended that patients were given advice about the circumstances that should prompt them to seek further medical help without delay.
The second set of draft recommendations published today were included in an update to the 2010 clinical guideline on diagnosing and managing COPD in over 16s.
The draft recommendations include when to use antibiotics to prevent exacerbations happening in the first place – via antibiotic prophylaxis.
“Prophylactic antibiotics should only be offered to carefully selected patients”
It recommends that antibiotics used in this way should only be offered to COPD patients who are most likely to benefit from them.
Dr Andrew Molyneux, chair of the COPD update committee, said: “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,” he said.
“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,” he added.
The COPD antimicrobial prescribing guideline is open for consultation until 31 July and the draft clinical guideline update is open for consultation until 8 August.
Alison Cook, director of policy at the British Lung Foundation, said: “This guidance will be vital in helping healthcare professionals to consider other potential options for treatment before being quick to prescribe antibiotics.
“They will also, for the first time, properly support people living with COPD to be able to manage their condition themselves,” she said. “We look forward to seeing the final guidance later in the year.”