Rethinking the use of antibiotics for COPD

New draft guidelines suggest restricting their use to severe flare-ups

Prescribing antibiotics for managing acute exacerbations of COPD is of limited use, but the drugs are handy when the flare-up is severe, according to the latest advice from the UK's National Institute for Health and Care Excellence (NICE).

The available evidence suggests that antibiotics have uncertain clinical benefit for patients with acute exacerbations of COPD, particularly those treated in the community.

That’s because only half of acute exacerbations are caused by bacterial infections, research shows.

For patients with an exacerbation that is not severe, NICE draft guidance recommends considering an antibiotic “but only after taking into account the number and severity of symptoms, previous exacerbation and hospital admission history, the risk of developing complications, and previous sputum culture and susceptibility results”.

In contrast, evidence shows that patients with severe