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You are in: Home > Chest Information > Chest Conditions > Bronchiectasis > Medical Treatment

Bronchiectasis

Bronchiectasis is a long–term condition, which means that it can't be cured. However, with suitable treatment and management you can learn to take control of your condition and improve your quality of life.

• Aims of treatment
• What does an exacerbation mean?
• Treatment for bronchiectasis
• Antibiotics and bronchiectasis

As well as taking any drugs that you are prescribed there is a lot you can do to help manage your condition and allow you to feel as well as possible, controlling your symptoms and avoiding infections.

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Aims of treatment

The aims of treatment / management are to:

• Identify and treat any underlying cause. This can help to prevent worsening of your bronchiectasis
• Control your daily symptoms
• Maintain, or improve, how well your lungs are working
• Reduce the number / frequency of chest infections (exacerbations)
• Improve your quality of life

It is important that you, and your medical team, learn about what symptoms are 'normal' for you and how to recognise if things are getting worse.

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What does an exacerbation mean?

An exacerbation is when your condition deteriorates and your symptoms increase. When this happens you need to access medical advice as soon as possible. Prompt treatment prevents further damage to your airways. You may need antibiotics and / or further treatment.

Contact your GP as soon as possible if you notice any of the following changes:

• Increased coughing
• Increased amount / thicker consistency of sputum
• Darker colour sputum
• Fever or chills
• Aches and pains
• Worsening breathlessness
• Blood in sputum (haemoptysis)

Where possible you will be treated at home. However, depending on your symptoms, you may need to be admitted to hospital during an exacerbation if you are very unwell, unable to cope at home, or if you need intra–venous (IV) antibiotics and it is not possible to be given them at home.

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Treatment for bronchiectasis

Some people with bronchiectasis need treatment only when they are having an exacerbation. Other people need treatment even when they are well to keep their condition stable. Your doctor will decide on what treatment, if any, is best for you. This can include:

• Antibiotics: orally, intra–venously (IV) or nebulised
• Nebulisers
• Inhalers
• Oxygen therapy

If you have bronchiectasis it is recommended that you have the flu and pneumococcal immunisations.

Surgery is not often recommended . It may be needed in life–threatening situations if your bronchiectasis is not controlled despite maximum medical treatment and it is localised to one area of your lung.

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Antibiotics and bronchiectasis

Antibiotics are a group of drugs that fight bacterial infections. Some antibiotics treat a wide range of bacterial infections. However, some bacteria are only sensitive to certain antibiotics.

• You will need an antibiotic if you have worsening symptoms, with increased sputum and darker colour.
• It is important to take a sputum sample to your GP when you first notice a change in your symptoms. so that you can begin taking antibiotics straightaway. This will make sure you are getting the correct antibiotic to treat the germs that are growing in your lungs, changing them if necessary when your results come back.

Over a period of time your sputum results may show your GP which antibiotics you have needed in the past and this treatment can be started immediately. This is important in preventing a delay in your treatment and may avoid an exacerbation.

Sometimes you may be prescribed more than one antibiotic. Usually you will be prescribed a course of antibiotics which will last between 7 and 14 days. Sometimes you may need antibiotics for a longer period.

Treatment with long–term antibiotics may be considered by your rerspiratory specialist if you have had 3 or more exacerbations in a year (which have required antibiotics).

Common antibiotics used in bronchiectasis

Organism (germ) found in sputum sample	Recommended initial treatment	Recommended second treatment if first does not work	Length of treatment
Streptococcus pneumoniae	Amoxicillin (tablets)	Clarithromycin (tablets)	7 to14 days
Haemophilus influenzae, (b-lactamase negative)	Amoxicillin (tablets)	Doxycycline (tablets) or Clarithromycin (tablets) or Ciprofloxacin (tablets) or Ceftriaxone intravenously (IV)	7 to 14 days
Haemophilus influenzae, b-lactamase positive	Co-amoxiclav (tablets)	Doxycycline (tablets) or Clarithromycin (tablets) or Ciprofloxacin (tablets) or Ceftriaxone (IV)	7 to 14 days
Moraxella catarrhalis	Co-amoxiclav (tablets)	Doxycycline (tablets) or Clarithromycin (tablets) or Ciprofloxacin (tablets) or Ceftriaxone (IV)	7 to 14 days
Staphylococcus aureus (MSSA)	Flucloxacillin (tablets)	Clarithromycin (tablets)	7 to 14 days
Staphylococcus aureus (MRSA) Oral preparations	Rifampicin (tablets) + Doxycycline (tablets)	Rifampicin (tablets) + Trimethoprim (tablets)	14 days
Staphylococcus aureus (MRSA) Intravenous preparations	Vancomycin (IV) or Teicoplanin (IV)	Linezolid (tablets)	14 days
Coliforms e.g. Klebsiella, Enterobacter	Ciprofloxacin (tablets)	Ceftriaxone (IV)	7 to 14 days
Pseudomonas aeruginosa	Ciprofloxacin (tablets)	Ceftazidime (IV) or Tazobactam/ piperacillin (IV) or Meropenum (IV) or Aztreonam (IV) Combination therapy: The above can be combined with: gentamicin (IV) or colistin (IV) OR ciprofloxacin (tablets)	14 days

Adapted, with kind permission, from: 'NHS Lothian: Guideline for diagnosis and treatment of adult bronchiectasis (2010)'

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