22nd February 2024

Medical management

First line antibiotic agents consist of Penicillins such as Amoxicillin (or Doxycycline for Penicillin allergic patients). Sputum samples are an important component of investigations for suspected bronchiectasis with Pseudomonas Aeuruginosa, which is commonly identified as a source of bacterial colonisation. These exacerbation episodes will require a longer duration of intravenous antibiotics (minimum 2 weeks)

For non-Pseudomonas Aeruginosa colonised patients, Macrolides such as Azithromycin / Erythromycin should be considered as first line. Alternatively, Doxycycline can be used for patients allergic to Macrolides. 

Chronic colonisation of Pseudomonas will require broad-spectrum intravenous options such as Piperacillin/Tazobactam. Planned administration of intravenous antibiotics can be considered if more than >5 exacerbation episodes per year despite other treatments. Prophylactic oral antibiotics such as Azithromycin (250mg three times a day) are a pragmatic dose for patients with chronic colonisation.