Healthcare professionals should consider antimicrobial resistance when prescribing antibiotics for patients with chronic obstructive pulmonary disease (COPD), according to new draft antimicrobial guidance from the National Institute for Health and Care Excellence (NICE).
The guidance says that antibiotics should be offered to people who have a severe flare-up of COPD symptoms, but that when treating acute symptoms, other factors, such as the number or severity of symptoms, should be taken into account before offering antibiotics. This is based on the fact that only around half of acute exacerbations of COPD are caused by bacterial infections and will therefore respond to antibiotics.
“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,” said Mark Baker, director of the centre for guidelines at NICE.
“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.”
In addition to the draft guidance, NICE has also published an update of its 2010 clinical guideline on diagnosing and managing COPD in patients aged over 16 years. The new guidance provides advice on when to use antibiotic to prevent exacerbations happening in the first place and recommends that antibiotics used in this way should only be offered to people who are most likely to benefit from them.
“For some people who have frequent exacerbations, prophylactic antibiotics can help to reduce the frequency of exacerbations and admissions to hospital,” said Andrew Molyneux, chair of the COPD update committee.
“However, the benefits of prophylactic antibiotics needs to be balanced against the potential for more antibiotic resistance.”