Inhaled Antibiotics for Non-Cystic Fibrosis Bronchiectasis

Recommended Inhaled Antibiotics

The British Thoracic Society recommends inhaled colistin (1 MU twice daily) as first-line therapy for patients with bronchiectasis and chronic Pseudomonas aeruginosa infection who experience three or more exacerbations per year 1, 2
The European Respiratory Society recommends inhaled gentamicin as a second-line alternative to colistin for patients with bronchiectasis and chronic P. aeruginosa infection 2, 3
Inhaled colistin and gentamicin have demonstrated clinical benefits in extending time to exacerbation, reducing exacerbation rates, and improving quality of life in patients with non-CF bronchiectasis 1, 4

The European Respiratory Society suggests considering inhaled antibiotics for patients experiencing three or more exacerbations per year 1, 9
The British Thoracic Society recommends inhaled colistin as first-line therapy for P. aeruginosa colonized patients 2, 9

The British Thoracic Society advises avoiding the use of inhaled aminoglycosides if creatinine clearance is <30 mL/min 2
The European Respiratory Society recommends using inhaled aminoglycosides with caution in patients with significant hearing loss or balance issues 2
The British Thoracic Society suggests avoiding concomitant nephrotoxic medications 2

The British Thoracic Society recommends that prophylactic antibiotics should only be initiated by respiratory specialists 2
The European Respiratory Society suggests reviewing patients on long-term antibiotics every 6 months to assess efficacy, toxicity, and continuing need 4, 5

The European Respiratory Society recommends considering macrolides (azithromycin, erythromycin) as an alternative to inhaled antibiotics for patients who cannot tolerate them 2, 9
The British Thoracic Society suggests considering cyclical intravenous antibiotics in patients with ≥5 exacerbations and subjective ill health between exacerbations 6