Clinical Brief: Antibiotic Management in Bronchiectasis Exacerbations
Main Discussion Topics
- Antibiotics are a key component of exacerbation management and sometimes chronic therapy.
- Antibiotic selection should be guided by regular sputum cultures and patient history.
- Patient education about exacerbation recognition is crucial for timely intervention.
Key Points for Physicians
- Implement bronchiectasis action plans to help patients recognize exacerbation symptoms.
- Encourage regular sputum sample collection to guide antibiotic selection.
- Consider chronic, suppressive inhaled antibiotics for Pseudomonas aeruginosa.
- Monitor for nontuberculous mycobacterial (NTM) infection, especially in patients on chronic macrolides.
- In select patients, provide antibiotic “rescue packs” for patient-initiated treatment of exacerbations.
Notable Insights
Chronic macrolide therapy is often used for immunomodulatory and anti-inflammatory effects rather than antimicrobial properties but requires careful monitoring for development of NTM resistance.
Clinical Significance
A balanced approach to antibiotic management includes appropriate acute treatment of exacerbations, selective use of chronic suppressive therapy, and vigilant monitoring to prevent resistance.
