GPs should limit use of antibiotics for COPD, says draft NICE guidance

GPs have been urged to limit prescribing of antibiotics to prevent or treat COPD exacerbations, in draft NICE advice that highlights risks around effectiveness and antimicrobial resistance.

Draft NICE advice on antimicrobial resistance warns that half of acute flare-ups of COPD are not caused by bacterial infections - and therefore will not respond to antibiotics.

GPs considering antibiotics to treat an acute exacerbation that is not severe should take into account 'the number and severity of symptoms, previous exacerbation history, the risk of developing complications, and the risk of antimicrobial resistance with repeated courses of antibiotics', NICE says.

Meanwhile, a separate draft clinical guideline update on diagnosing and managing COPD in patients aged over 16 years old says GPs should limit prescribing of antibiotics as a means of preventing acute exacerbations to 'people who are most likely to benefit from them'. Smoking can trigger flare-ups, the draft advice warns - and patients should be advised to stop smoking before antibiotic prophylaxis is considered.

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.

GP prescribing

'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.'

For cases in which antibiotics are needed, the NICE guideline includes advice on the type, dosage and course length of treatment that may be needed. Where doctors choose not to prescribe antibiotics, NICE says patients should be told what signs should 'prompt them to seek further medical help without delay'.

Dr Andrew Molyneux, chair of NICE's 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.

'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.'

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.

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