Bronchiectasis management

Bronchiectasis management

Bronchiectasis is a progressive respiratory disease characterized by permanent dilatation of the bronchi and associated with a clinical syndrome of cough, sputum production, and recurrent respiratory infections.

Investigations

• FBP

• ESR

• Serum IgE

• IgE to Aspergillus

• Serum immunoglobulins:

  • IgG

  • IgA

  • IgM

• CXR

• Sputum culture and sensitivity

• CT chest

  • CT contrast if suspicion of pulmonary embolism (PE)

  • HRCT

• Bronchoscopy

Non-pharmacological treatment

• Physiotherapy and postural drainage

• Avoid smoking

• Airway clearance techniques

• Pulmonary rehabilitation

• Respiratory care during childhood measles helps prevent the development of bronchiectasis in children

Pharmacological treatment

Consider antibiotics in patients with bronchiectasis who have more than 3 exacerbations per year.

Empirical treatment may be initiated while awaiting culture and sensitivity results.

Adults

• Ciprofloxacin (PO) 500 mg every 12 hours for 10 days

AND

• Metronidazole (PO) 400 mg every 8 hours for 10 days

Children

• Amoxicillin (PO) 40 mg/kg in 2 divided doses for 7 days

AND

• Metronidazole (PO) 7.5 mg/kg every 8 hours for 5–7 days

If Pseudomonas aeruginosa is suspected

Treatment should be guided by culture and sensitivity results.

Option 1

• Ceftazidime (IV) 2 g every 8 hours for 14 days

OR

Option 2

• Piperacillin + Tazobactam (FDC) (IV) 4.5 g every 8 hours for 14 days

AND

• Itraconazole (PO) 100–200 mg every 12 hours

Prevention of infection

Option 1

• Ciprofloxacin (PO) 500 mg every 24 hours for 7–14 days

OR

Option 2

• Erythromycin (PO) 250–500 mg every 24 hours for 7–14 days