NICE restricts use of antibiotics in draft COPD guidance

NICE has published draft guidance restricting use of antibiotics in patients with chronic obstructive pulmonary disease (COPD), as in many cases the treatment is inappropriate and could lead to an increase risk of development of antimicrobial resistance.

The guidance recommends should be offered to people who have a severe flare-up of symptoms, known as a severe cute exacerbation.

However other factors should be taken into when considering use of antibiotics if the exacerbation is not severe.

These include number and severity of symptoms, previous exacerbation history, risk of developing complications, and the risk of developing antimicrobial resistance with repeated courses of antibiotics.

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

NICE’s clinical guidance applies to England and could apply to devolved NHS organisations in Scotland, Wales and Northern Ireland should they decide to adopt it.

In its guidance NICE noted that acute exacerbations of COPD can be caused by a range of factors including viral infections and smoking.

Only around half of acute exacerbations are caused by bacterial infections, so many will not respond to antibiotics.

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

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

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 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.