Warning

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
Consider oral switch after 48 hours

Pseudomonas aeruginosa on recent sputum culture (ciprofloxacin-sensitive)

For oral treatment

Treatment

Ciprofloxacin 750mg every 12 hours
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
Duration: 14 days

Specific therapy when organism isolated from sputum culture, if susceptible

Psuedomonas aeruginosa (oral treatment indicated)

Treatment

Ciprofloxacin 750mg twice daily (oral)
Duration: 14 days

Last reviewed: 31/10/2023

Next review date: 31/10/2026

Author(s): Antimicrobial Management Team.

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Alison Macdonald, Area Antimicrobial Pharmacist.

Document Id: AMT157