Bronchiectasis

Antimicrobial prescribing: NHS Forth Valley
NHS Forth Valley

NICE Clinical Knowledge Summaries – Bronchiectasis: Infective Exacerbation

BTS Guideline - Non CF Bronchiectasis

 

Treatment indicated if there are signs of infection e.g.

  • change in sputum colour/volume,
  • increased dyspnoea
  • increased cough
  • fever
  • increased wheeze
  • fatigue
  • change in clinical signs.

Sputum culture essential to identify causative organism and monitor antibiotic resistance. 

Initial treatment following sputum culture: previous cultures and sensitivities should guide antibiotic choice.

  • Review the response to empirical treatment when sputum culture and sensitivity results are available.:
  • If good response, continue with the prescribed antibiotic + do not change the treatment based on the culture results.
  • If poor or no response, prescribe a different antibiotic, guided by the results of sputum culture and sensitivity testing.

Consider bronchodilators and ensure expectoration techniques are being carried out. Home antibiotic therapy (IV or nebulised) or long term azithromycin therapy should only be commenced after consultation with Respiratory Physician/Infection specialist.

 

If clinical failure despite two courses of different classes of antibiotic - discuss with Respiratory team or discuss with OPAT service for consideration of outpatient IV antibiotic therapy 

Drug details

Course length should be based on an assessment of the severity of bronchiectasis, exacerbation history, severity of exacerbation symptoms, previous culture and susceptibility results, and response to treatment.

Higher risk of treatment failure includes repeated courses of antibiotics, previous sputum culture with resistant or atypical bacteria, or a higher risk of developing complications.

[10 days should be adequate for majority of exacerbations]

First choice empirical antibiotics if no previous cultures available:

Amoxicillin

 

 

500mg TDS

 

 

7-14 Days

or

Doxycycline

(avoid co-administration of Ca/Mg/Iron preps)

 

200mg stat then 100mg OD

 

7-14 days

Pseudomonas colonisation: 

First choice empirical antibiotic 

i.e. Amoxicillin or Doxycycline

 

as above

 

7-14 days

Pseudomonas colonisation and clinical failure on first choice antibiotic:

Ciprofloxacin

(avoid co-administration of Ca/Mg/Iron preps)

 

 

 

750mg BD

 

 

7-14 days

If Pseudomonas colonisation and no response to 1st line therapy and high dose oral ciprofloxacin (or resistance) - consider referral to OPAT for potential IV therapy, assuming hospital admission not otherwise required.

Other organisms (e.g. Haemophilus influenzae, Staph aureus):

 

 

7-14 days