CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Bronchiectasis - Management
Which antibiotic should I prescribe for an infective exacerbation of bronchiectasis?
- Previous microbiology cultures, when available, should guide antibiotic choice.
- When previous microbiology cultures are not available:
- Prescribe according to local protocols where available, or
- Prescribe amoxicillin 500 mg three times a day (for 10–14 days). Clarithromycin 500 mg twice a day, erythromycin 500 mg four times a day, or doxycycline (adults only) 200 mg stat and then 100 mg once a day (all for 10–14 days) are alternatives for people allergic to penicillin.
- For further information on dosing regimens for empirical antibiotic treatment, see Prescriptions.
Table 1. Recommended antibiotics (with doses for adults) for acute exacerbations of bronchiectasis if sputum results from a previous sputum sample are available.
Organism | First-line antibiotic | Second-line antibiotic | Duration |
|---|
Streptococcus pneumoniae | Amoxicillin 500 mg TDS | Clarithromycin 500 mg BD | 10–14 days |
Haemophilus influenzae (beta-lactamase negative) | Amoxicillin 500 mg TDS or Amoxicillin 1 g TDS or Amoxicillin 3 g BD | Clarithromycin 500 mg BD or Doxycycline 200 mg stat, then 100 mg OD* | 10–14 days |
Haemophilus influenzae (beta-lactamase positive) | Co-amoxiclav 625 mg TDS | Clarithromycin 500 mg BD or Doxycycline 200 mg stat, then 100 mg OD* | 10–14 days |
Moraxella catarrhalis | Co-amoxiclav 625 mg TDS | Doxycycline 200 mg stat, then 100 mg OD* | 10–14 days |
Staphylococcus aureus (MSSA) | Flucloxacillin 500 mg QDS | Clarithromycin 500 mg BD | 10–14 days |
Staphylococcus aureus (MRSA) | Rifampicin‡ PLUS trimethoprim 200 mg BD | Rifampicin PLUS doxycycline 100 mg BD‡§ | 10–14 days |
Coliforms (such as Klebsiella or enterobacter) | Ciprofloxacin 500 mg BD | Intravenous antibiotics | 10–14 days |
Pseudomonas aeruginosa | Ciprofloxacin 500 mg BD† or Ciprofloxacin 750 mg BD | Intravenous antibiotics | 10–14 days |
* Doxycycline is not recommended as a second-line choice for Haemophilus influenzae infection in children. † Ciprofloxacin is recommended as a second-line choice for Moraxella catarrhalis or Pseudomonas aeruginosa infection in children (benefits thought to outweigh theoretical risk of arthropathy). See the BNF (British National Formulary) for dosage in children. ‡ For adults weighing < 50 kg, give rifampicin 450 mg OD. For adults weighing > 50 kg, give rifampicin 600 mg OD. § Rifampicin plus doxycycline is not recommended as a second-line choice for children with MRSA. Seek specialist advice if first-line treatment is contraindicated. For children's doses, see the BNF (British National Formulary). |
|
© NHS Institute for Innovation and Improvement