12.4 Infective Exacerbation of Bronchiectasis

Type of Infection	First Line (with Dosage and Duration)	Alternative First Line (with dosage and Duration)	Comments
OPD	Tab Amoxicillin- clavulanate 1g BD for 5- 7 days	Tab Cefuroxime 500 mg BD for 5-7 days	Symptoms of infective exacerbation include fever and sputum purulence.
IPD	Inj Piperacillin- tazobactam 4.5g IV q6h for 5-7 days Or Inj Cefoperazone - sulbactam 3g IV BD for 5-7 days	Inj Meropenem 1g TDS Or Inj Imipenem- cilastatin 500mg q6h for 5-7 days	Sputum culture is recommended for targeted therapy. Duration may be prolonged to 14 days if very slow improvement in symptoms. Avoid empiric use of fluoroquinolones. Use only as targeted therapy (after culture result) and after ruling out TB.

Type of Infection

First Line
(with Dosage and Duration)

Alternative First Line
(with dosage and Duration)

Comments

OPD

Tab Amoxicillin- clavulanate 1g BD for 5- 7 days

Tab Cefuroxime 500 mg BD for 5-7 days

Symptoms of infective exacerbation include fever and sputum purulence.

IPD

Inj Piperacillin- tazobactam 4.5g IV q6h for 5-7 days

Inj Cefoperazone - sulbactam 3g IV BD for 5-7 days

Inj Meropenem 1g TDS

Inj Imipenem- cilastatin 500mg q6h for 5-7 days

Sputum culture is recommended for targeted therapy. Duration may be prolonged to 14 days if very slow improvement in symptoms. Avoid empiric use of fluoroquinolones. Use only as targeted therapy (after culture result) and after ruling out TB.

For common etiological agents of Infective Exacerbation of Bronchiectasis, see Annexure B.12.4

References

1. Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J 2017; 50: 1700629 [https://doi.org/ 10.1183/13993003.00629-2017 ]