Antibiotic Treatment for Bronchiectasis

Acute Exacerbation Management

The European Respiratory Society recommends treating acute exacerbations with 14 days of oral antibiotics selected based on prior sputum microbiology 1, 2
For patients with acute deterioration, treat exacerbations with empirical therapy immediately, based on expert consensus and clinical outcome data 2
Use 14-day antibiotic courses for all acute exacerbations, as recommended by the European Respiratory Society and Thorax 1, 2

The European Respiratory Society recommends initiating long-term antibiotics only for patients with ≥3 exacerbations per year after optimizing airway clearance and treating underlying causes 1, 2
For chronic Pseudomonas aeruginosa infection, use inhaled colistin as the first-line approach, as recommended by Thorax 2
For non-Pseudomonas infections, use oral macrolides, such as azithromycin, as the first-line approach, as recommended by the European Respiratory Society and Thorax 1, 2

Review patients on long-term antibiotics every 6 months for efficacy, toxicity, and continuing need, as recommended by Thorax 2
Monitor sputum culture and sensitivity regularly, recognizing that in vitro resistance may not affect clinical efficacy, as recommended by Thorax 2
The European Respiratory Society strongly recommends against using inhaled corticosteroids for bronchiectasis treatment unless the patient has comorbid asthma or COPD, with moderate quality evidence 1