Bronchiectasis (Antimicrobial)
TAM (Treatments and Medicines) NHS Highland
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Diagnosis and management:
Treatment of infective exacerbation (adults only)
- Antibiotic choice should be based on previous culture and sensitivity results where possible.
- A sputum sample should be sent to establish the cause of the exacerbation prior to commencing empiric treatment.
- Antibiotic choice and dosage should be reviewed when results become available.
Note: other Pseudomonas species (eg, Pseudomonas fluorescens) may not require specific treatment. Discuss with Microbiology as required.
For organisms not included in this list, please discuss significance and antibiotic treatment options with Microbiology.
(Table based on BTS Bronchiectasis Guidance December 2018, adapted with SMVN EUCAST Guidance from March 2021 via SAPG)
For glossary of terms see Glossary.
Drug details
No previous positive sputum culture or recent hospitalisation
For oral treatment
First line
Amoxicillin 1g every 8 hours
Duration:
- 7 days if mild bronchiectasis, non-severe symptoms of infection, not known/suspected Pseudomonas infection and satisfactory response by day 7.
- 14 days if moderate to severe bronchiectasis, more severe symptoms of infection, known/suspected Pseudomonas.
Second line/penicillin allergy
Doxycycline 200mg on first day then 100mg every 12 hours
Duration:
- 7 days if mild bronchiectasis, non-severe symptoms of infection, not known/suspected Pseudomonas infection and satisfactory response by day 7.
- 14 days if moderate to severe bronchiectasis, more severe symptoms of infection, known/suspected Pseudomonas.
No previous positive sputum culture but recent hospitalisation or prior antibiotic treatment
For oral treatment
First line
Co-amoxiclav 625mg every 8 hours PLUS amoxicillin 500mg every 8 hours
Duration:
- 7 days if mild bronchiectasis, non-severe symptoms of infection, not known/suspected Pseudomonas infection and satisfactory response by day 7.
- 14 days if moderate to severe bronchiectasis, more severe symptoms of infection, known/suspected Pseudomonas.
Second line/penicillin allergy
Levofloxacin 500mg twice daily
Duration:
- 7 days if mild bronchiectasis, non-severe symptoms of infection, not known/suspected Pseudomonas infection and satisfactory response by day 7.
- 14 days if moderate to severe bronchiectasis, more severe symptoms of infection, known/suspected Pseudomonas.
No previous positive sputum culture
IV treatment indicated
First line
Co-amoxiclav 1.2g every 8 hours
Consider oral switch after 48 hours
Second line/penicillin allergy
Levofloxacin 500mg twice daily (see BNF warnings and MHRA Drug Safety Alert (updated 22 January 2024))
Consider oral switch after 48 hours
Pseudomonas aeruginosa on recent sputum culture (ciprofloxacin-sensitive)
For oral treatment
Treatment
Ciprofloxacin 750mg every 12 hours (see BNF warnings and MHRA Drug Safety Alert (updated 22 January 2024))
Duration: 14 days
Previous Psuedomonas aeruginosa on recent sputum culture
IV treatment indicated
First line/penicillin allergy
Ceftazidime 2g every 8 hours
Duration: 14 days
Second line
Piperacillin/tazobactam 4.5g every 6 hours
Duration: 14 days
Specific therapy when organism isolated from sputum culture, if susceptible
Streptococcus pneumoniae (oral)
First line
Amoxicillin 500mg every 8 hours
Duration: 14 days
Second line
Doxycycline 100mg twice daily
Duration: 14 days
Specific therapy when organism isolated from sputum culture, if susceptible
Haemophilus influenzae
First line (oral)
Amoxicillin 1g every 8 hours
Duration: 14 days
Second line/penicillin allergy (oral)
Doxycycline 100mg twice daily
Duration: 14 days
Specific therapy when organism isolated from sputum culture, if susceptible
Haemophilus influenzae (amoxicillin resistant, co-amoxiclav sensitive)
First line (oral)
Co-amoxiclav 625mg every 8 hours PLUS amoxicillin 500mg every 8 hours
Duration: 14 days
Second line/penicillin allergy (oral)
Doxycycline 100mg twice daily
Duration: 14 days
Specific therapy when organism isolated from sputum culture, if susceptible
Moraxella catarrhalis
First line (oral)
Co-amoxiclav 625mg every 8 hours
Duration: 14 days
Second line/penicillin allergy (oral)
Doxycycline 100mg twice daily
Duration: 14 days
Specific therapy when organism isolated from sputum culture, if susceptible
Staphylococcus aureus (MSSA)
First line (oral)
Flucloxacillin 1g every 6 hours
Duration 14 days
Second line/penicillin allergy
Doxycycline 100mg twice daily (oral) OR IV Vancomycin as per TAM Vancomycin guidelines
Duration: 14 days
Specific therapy when organism isolated from sputum culture, if susceptible
Staphylococcus aureus (MRSA)
- Consider eradication treatment
- Refer to Complex Bronchiectasis Clinic
First line
Oral treatment based on sensitivities.
Discuss with Microbiology, as required.
IV Vancomycin (as per TAM guidance) if no oral options or IV therapy indicated
Duration: 14 days
Specific therapy when organism isolated from sputum culture, if susceptible
Coliforms, eg, Klebsiella sp, Enterobacer sp.
Treatment
- Consider whether this is a contaminant of the aerodigestive tract.
- Consider hiatus hernia/reflux.
- If indicated, treat with narrowest spectrum agent (discuss with Microbiology, if required).
Specific therapy when organism isolated from sputum culture, if susceptible
Pseudomonas aeruginosa (IV treatment indicated)
- These patients can benefit from nebulised antibiotics.
- Discuss alternative options with Microbiology and Respiratory, as required.
First line
Ceftazidime 2g every 8 hours IV
Duration: 14 days
Second line
Piperacillin/tazobactam 4.5g every 6 hours IV
Duration: 14 days
Penicillin allergy
Ciprofloxacin 750mg twice daily (see BNF warnings and MHRA Drug Safety Alert (updated 22 January 2024))
Duration: 14 days
Specific therapy when organism isolated from sputum culture, if susceptible
Psuedomonas aeruginosa (oral treatment indicated)
Treatment
Ciprofloxacin 750mg twice daily (oral) (see BNF warnings and MHRA Drug Safety Alert (updated 22 January 2024))
Duration: 14 days