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a spirometry image 2July 13 2018

Draft guidance is calling for health professionals to consider the risk of antimicrobial resistance when prescribing for chronic obstructive pulmonary disease (COPD).

NICE has said that prescribers need to decide whether antibiotics are really needed for treating or preventing a flare up of COPD symptoms.

The draft 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,” said NICE.

Factors such as viral causes or smoking should be part of the prescribing assessment. In other cases, NICE is proposing the following: “Consider an antibiotic for people with an acute exacerbation of COPD that is not severe, but only after taking into account:

  • the number and severity of symptoms, bearing in mind that for people with less severe or fewer symptoms who are having treatment in the community there is evidence of uncertain benefit of antibiotics;
  • whether they need to go into hospital for treatment (see the NICE guideline on COPD);
  • previous exacerbation and hospital admission history, and the risk of developing complications;
  • previous sputum culture and susceptibility results;
  • the risk of antimicrobial resistance with repeated courses of antibiotics.”

NICE has also issued a separate update to its 2010 clinical guideline on diagnosing and managing COPD in over 16s.

Commenting on the proposed guidance, 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 other draft clinical guideline update states when to use antibiotics to prevent exacerbations happening in the first place (antibiotic prophylaxis). “It recommends that antibiotics used in this way should only be offered to people who are most likely to benefit from them,” said NICE.

Links:
NICE announcement     
NICE: ‘Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing NICE guideline Draft for consultation July 2018’.      
NICE ‘Chronic obstructive pulmonary disease in over 16s: diagnosis and management (update)’ 

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