Acute Exacerbation of Bronchiectasis (Non-Cystic-Fibrosis)
NHSL Antimicrobial Guidelines
Send a sputum sample for culture and susceptibility testing. Check if patient has respiratory management plan for exacerbations.
Offer an antibiotic. When choosing an antibiotic take account of severity of symptoms, risk of treatment failure and current susceptibility data. People who may be at a higher risk of treatment failure include repeated antibiotic courses, previous sputum culture with resistant/atypical bacteria, or at a higher risk of developing complications.
Base course length on severity of bronchiectasis, exacerbation history, severity of exacerbation symptoms, and response to treatment.
Do not routinely offer antibiotic prophylaxis to prevent exacerbations. Seek specialist advice in people with repeated acute exacerbations.
Drug details
Drug
First choice empirical treatment:
Amoxicillin
Dosage
500mg
Duration
3 times a day 7-14 days (preferred if pregnant)
Drug
OR
Doxycycline
Dosage
200mg
100mg
Duration
on day 1 then
once daily for 7-14 days (not in under 12s)
Drug
OR
Clarithromycin
Dosage
500mg
Duration
twice daily for 7-14 days
Drug
Alternative choice empirical treatment (if higher risk of treatment failure):
Balance need for broad spectrum treatment with risk of Clostridium difficile infection
Co-amoxiclav
Dosage
500/125mg
Duration
3 times a day 7-14 days
Drug
OR
Levofloxacin
Dosage
500mg
Duration
once daily or twice daily 7-14 days (adults only: with specialist advice where co-amoxiclav cannot be used, consider safety issues and dose reductions in renal impairment)
Drug
OR
Ciprofloxacin
Dosage
Duration
7-14 days (children only: with specialist advice where co-amoxiclav cannot be used, consider safety issues)
Please see BNFC for dosing information in children.