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Bronchiectasis - Management
Basis for recommendation
Recommendations on the use of antibiotics are largely based on the expert opinion of the British Thoracic Society [British Thoracic Society, 2010].
Choice of antibiotic
- Recommended antibiotics reflect the likely pathogens. The commonest bacteria isolated during infective exacerbations of bronchiectasis include Haemophilus influenzae, Pseudomonas aeruginosa, Moraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus (the presence of which raises the suspicion of cystic fibrosis), and mycobacterium. Sometimes no organism is found [O'Donnell, 2008].
- Amoxicillin is a reasonable first-line empirical choice in the absence of previous sputum results as it has good activity against H. influenzae and S. pneumoniae [Murray and Hill, 2009; British Thoracic Society, 2010]. In addition, it is usually well tolerated and is inexpensive.
- Clarithromycin and erythromycin are recommended as alternatives for people with penicillin allergy [Murray and Hill, 2009; British Thoracic Society, 2010]. They are active against H. influenzae, S. pneumoniae, S. aureus (meticillin sensitive) and M. catarrhalis. However, resistance to H. influenzae is increasing [Bryskier and Butzler, 2003].
- Doxycycline is an alternative empirical antibiotic for people with penicillin allergy [HPA, Personal Communication, 2010]. It is active against H. influenzae, S. pneumoniae, S. aureus and M. catarrhalis. It is available as a convenient, once-daily regimen (after an initial loading dose), is well tolerated by most people, and is relatively inexpensive.
Duration of antibiotic treatment
- The duration of treatment is based on the expert opinion of the British Thoracic Society [British Thoracic Society, 2010] and the opinions of CKS expert reviewers, who also recommend some flexibility in the duration of antibiotic treatment. Not all people may require the full 14 days. Clinical judgement is advised due to the weakness of the evidence base.
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