Acute Exacerbation of Bronchiectasis (Non-Cystic-Fibrosis)

Warning

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.

Editorial Information

Last reviewed: 18/05/2022

Next review date: 18/05/2025

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick, Heather Boyle.

Version: V1

Approved By: AMC; ADTC

Reviewer name(s): NHS Lanarkshire Antimicrobial Management Committee.

Document Id: June 2022