Priority 10 from the COPD Exacerbation PSP

UNCERTAINTY: What are the risks and benefits of long-term antibiotics to prevent COPD exacerbations, and how should they be best used?  (JLA PSP Priority 10)
Overall ranking 10
JLA question ID 0104/10
Explanatory note Antibiotics are sometimes used long-term in COPD not to treat, but to prevent exacerbations.  This is called 'prophylaxis'.  However, long term use might cause side-effects, or problems because the bacteria become resistant to the antibiotics.  This question aims to understand the pros and cons of using antibiotics in this way, how to use them best and therefore to understand which patients are most likely to benefit from them. 
Evidence

The question has partially been addressed in the evidence base. 

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009764.pub3/full
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010257.pub2/full 
Health Research Classification System category  Respiratory
Extra information provided by this PSP
Original uncertainty examples

Should more patients be on prophylactic steroids and/or antibiotics to prevent exacerbations? ~ To what extent does Long term prophylactic antibiotics affect the frequency or duration of exacerbations ~ To what extent does Antibiotics and /oral steroids started at the onset of exacerbation. affect the frequency or duration of exacerbations ~ I take azrthmycin as a preventative daily. I’m scared of antibiotic resistance. Trials of limited periods of different antibiotics to see if dependency lessons or immunity could be beneficial. ~ do I need to keep taking azithromycin ~ How long is it ok to take azithromycin as a prophylactic, I take it 3times a week
Does Azithromycin 3 days a week help?
Submitted by Patient, Healthcare professional 
PSP information
PSP unique ID 0104
PSP name COPD Exacerbation PSP
Total number of uncertainties identified by this PSP. 51 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 1 April 2021