Bronchiectasis

J47

GENERAL MEASURES

Patient education.
Advice on early self-referral for suspected acute infections.
Physiotherapy: Regular chest clearance exercises (20 minutes morning and night) are the mainstay of therapy and must be emphasised and demonstrated to the patients, including cough and chest drainage techniques, and must be emphasised repetitively.

MEDICINE TREATMENT

Antimicrobial therapy

Antibiotic therapy in patients with bronchiectasis should only be used when there is either systemic evidence of sepsis such as pyrexia or increasing sputum purulence or volume. Antibiotic choices should be guided by sputum microscopy, culture and sensitivity. The number and duration of physiotherapy sessions should be increased.
Treatment may need to be prolonged for two weeks, depending on the extent of the bronchiectasis and the organisms suspected.

In patients otherwise stable and before culture results:

  • Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly for 10 days, or longer depending on the response.

LoEIII [18]

Severe penicillin allergy: (Z88.0)

  • Azithromycin, oral, 500 mg daily for 10 days, or longer depending on the response.

More severely ill patients may require hospitalisation and initiation of parenteral antibiotic therapy.

Sputum microscopy, culture and sensitivity determination are indicated in all cases.

  • Ceftriaxone 2g, IV, daily, until patient apyrexial for 24 hours.

LoEIII [19]

Follow with:

  • Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly.

LoEIII [20]

If Pseudomonas infection is confirmed on culture: (B96.5)

ADD

  • Ciprofloxacin, oral, 750 mg 12 hourly for 7 days.

Severe penicillin allergy: (Z88.0)

  • Moxifloxacin, oral, 400 mg daily for 7 days.

If penicillin allergic and unable to tolerate oral therapy: (Z88.0)

Management of these patients should be discussed with a specialist for possible referral and alternative parenteral therapy:

  • Moxifloxacin, IV, 400 mg daily infused over 60 minutes.

LoEIII [21]

Switch to oral treatment once able to take orally:

  • Moxifloxacin, oral, 400mg daily.

Subsequent antibiotic therapy should be based on results of sputum investigations. A sputum smear for Acid Fast Bacilli (AFB), followed by culture if positive, is recommended in patients with a poor response to antibiotics as patients with bronchiectasis are at increased risk for infection with Non-tuberculous Mycobacteria which will not be detected by XpertMTB/RIF® PCR assay.

Inhaled bronchodilators

Bronchodilators may be used as for COPD, if airflow obstruction is present. There is no indication for inhaled corticosteroids.
Any asthmatic component (i.e. reversible obstruction should be treated in the usual way, as for asthma).

Prophylaxis (Z25.1)

For frequent severe exacerbations, consult a specialist.

REFERRAL

  • For exclusion of a possible foreign body.
  • For assessment for surgical removal of a bronchiectatic segment.
  • Major haemoptysis.