Table 6

Common organisms associated with acute exacerbation of bronchiectasis and suggested antimicrobial agents- adults

OrganismRecommended first line treatmentLength of treatmentRecommended second line treatmentLength of treatment
Streptococcus pneumoniaeAmoxicillin
500 mg Three times a day
14 daysDoxycycline 100 mg BD14 days
Haemophilus influenzae- beta lactamase negativeAmoxicillin
500 mg Three times a day
Or
Amoxicillin
1G Three times a day
Or
Amoxicillin 3G BD
14 daysDoxycycline 100 mg BD
Or
Ciprofloxacin
500 mg or 750 mg BD
Or
Ceftriaxone 2G OD (IV)
14 days
Haemophilus influenzae- beta lactamase positiveAmoxicillin with clavulanic acid 625 one tablet Three times a day14 daysDoxycycline
100 mg bd
Or
Ciprofloxacin
500 mg or 750 mg BD
Or
Ceftriaxone 2G OD (IV)
14 days
Moraxella catarrhalisAmoxicillin with clavulanic acid 625 one tablet Three times a day14 daysClarithromycin 500 mg BD
Or
Doxycycline 100 mg BD
Or
Ciprofloxacin
500 mg or 750 mg BD
14 days
Staphylococcus aureus (MSSA)Flucloxacillin
500 mg Four times a day
14 daysClarithromycin
500 mg BD
Or
Doxycycline 100 mg BD
Or
Amoxicillin with clavulanic acid 625 one tablet Three times a day
14 days
Staphylococcus aureus (MRSA)
Oral preparations
Doxycycline 100 mg BD
Rifampicin (<50 Kg)
450 mg OD
Rifampicin (>50 Kg)
600 mg OD
Trimethoprim
200 mg BD
14 daysThird line
Linezolid
600 mg BD
14 days
Staphylococcus aureus (MRSA)
Intravenous preparations
Vancomycin 1 gm BD* (monitor serum levels and adjust dose accordingly) or Teicoplanin 400 mg OD14 daysLinezolid
600 mg BD
14 days
Coliforms for example, Klebsiella, enterobacterOral Ciprofloxacin
500 mg or 750 mg BD
14 daysIntravenous
Ceftriaxone
2G OD
14 days
Pseudomonas aeruginosaOral Ciprofloxacin
500 mg bd
(750 mg bd in more severe infections)
14 daysMonotherapy:
Intravenous
Ceftazidime
2G TDS
or
Piperacillin with tazobactam
4.5G TDS
or
Aztreonam
2G TDS
or
Meropenem
2G TDS

Combination therapy
The above can be combined with gentamicin or tobramycin or
Colistin 2MU TDS (under 60 kg, 50 000–75 000 Units/kg daily in 3 divided doses)

Patients can have an in vivo response despite in vitro resistance. Caution with aminoglycosides as highlighted below but also if previous adverse events, particularly previous
ototoxicity/acute kidney injury due to aminoglycosides
14 days
  • BNF 72 (March 2017); OD once daily; BD, twice daily; IV intravenous.

    Caution with aminoglycosides in pregnancy, renal failure, elderly or on multiple other drugs.

    *Elderly (over 65 years), 500 mg Vancomycin every 12 hours or 1 g once daily.