Bronchiectasis/end stage lung disease

- Permanent abnormal dilatation of bronchi and bronchioles due to repeated cycles of airway infection and inflammation, leading to chronic cough, sputum hypersecretion, wheeze and dyspnea.

- Diagnosis: high resolution CT showing dilated and thickened airways - investigate and treat possible causes; 50-80% of cases may be idiopathic.

- Antibiotics with good lung penetration:

  • macrolides
  • quinolones.

Acute exacerbation

- Sputum for bacterial and mycobacterial culture recommended.

 
Usual Pathogens

H. influenzae
P. aeruginosa
Other non-fermenting Gram negative bacilli
S. aureus/MRSA
S. pneumoniae
Nontuberculous mycobacteria
Aspergillus spp

 

Empiric Therapy Dose Duration
Tailor antibiotic to sputum C&S results   Optimal duration of therapy unknown - anywhere from 7-21 days has been recommended depending on pathogen and previous response to therapy