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Bronchiectasis- antibiotics

Bronchiectasis ( non-cystic ) -acute exacerbation antibiotic prescribing

Send sputum for M/C Offer an antibiotic-NICE suggests to offer some general and safety-netting advice
 SEs of antibiotics particularly diarrhoea
 To seek further medical help if
○ symptoms worsen rapidly at any time or
○ person becomes systemically unwell

When sputum culture result becomes available
 review choice only change antibiotic if
○ bacteria are resistant and
○ symptoms are not already improving
○ using marrow spectrum antibiotics when possible

NICE advices to reassess the situation at any time if symptoms worsen rapidly or significantly- taking into account
 other possible diagnosis as pneumonia symptoms or signs of something more serious , such as cardiorespiratory failure or sepsis ( arrange emergency admission ) previous antibiotic use which may have led to resistant bacteria

Adults 18 and over-Amoxicillin 500 mg x tds for 7-14 days
preferred choice for pregnant women Doxycyline 200 mg day 1 and then 100 mg/ D x 7-14 days Clarithromycin 500 mg bd x 7-14 days

Alternative choice ( if the person at high risk of treatment failure ) for empirical treatment when susceptibility data N/A- be guided by most recent sputum C/S where possible-Co-amoxiclav 500/125 tds x 7-14 days Levofloxacin 500 mg once or twice/day x 7-14 days

First line IV -if unable to take oral antibiotics or severely unwell – empirical treatment when M/C not available. Be guided by most recent sputum result when available-Co-amoxclav 1.2 gm tds Piperacillin with tazobactam 4.5 gm tds incd if needed to 4.5 gm qds Levofloxacin 500 mg od or bd. Review IV antibiotics after 48 hr and consider stepping down to oral antibiotics where possible for a total antibiotic course of 7-14 days

When a person is on prophylactic antibiotic , treatment should be from an antibiotic from a different class.○ severity of underlying bronchiectasis
○ exacerbation history
○ severity of exacerbation symptoms
○ previous M/C results and response

Following people may be at higher risk of treatment failure treatment with repeated courses of antibiotics previous sputum culture with resistant or atypical bacteria higher risk of developing complications

Fluoroquinolone antibiotics can lead to disabling and potentially long-lasting side effects mainly involving
○ muscles ○ tendons ○ bones ○ nervous system

NICE quotes recommendations from EMA to advice us not to use them for mild or moderately severe infections unless other antibiotics cannot be used

Refer to hospital if a more serious illness or condition suspected as

○ cardiorespiratory failure
○ sepsis

Seek specialist advice if
 symptoms do not improve with repeated courses of antibiotics bacteria are resistant to oral antibiotics oral antibiotics cannot be administered- to arrange IV antibiotics ( at home or in the community if appropriate )

Reference-Bronchiectasis ( acute exacerbation ) : antimicrobial prescribing NICE December 2018

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