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Page last updated:
31 July 2020
The information below is based on NICE NG117 Bronchiectasis (non-cystic fibrosis), acute exacerbation: antimicrobial prescribing (December 2018).
An acute exacerbation of bronchiectasis is a sustained worsening of normal symptoms and signs usually over several days.
Worsening local symptoms, with or without increased wheeze, breathlessness or haemoptysis, can include:
Fever or pleurisy may also be present.
Obtain a sputum sample from people with an acute exacerbation of bronchiectasis and send for culture and susceptibility testing. Do not delay treatment whilst awaiting culture result.
When results of sputum culture and susceptibility testing are available:
Start empirical antibiotics for people with an acute exacerbation of bronchiectasis (see sliders below)
Seek specialist advice if the patient:
Refer to hospital if the patient:
Patients with bronchiectasis are at increased risk of respiratory infections, and some are likely to be at an elevated risk of a poor outcome if infected with COVID-19.
It may be difficult to distinguish whether new symptoms are due to COVID-19 or due to an exacerbation or flare-up of bronchiectasis.
Advise patients to ensure they complete their airway clearance exercises regularly - this clears mucus from the lungs and reduces the risk of a flare-up (exacerbation).
Typically, exacerbations of COPD, bronchiectasis and asthma are not associated with a high fever.
When choosing an antibiotic, take account of:
Take the opportunity to consider the ongoing management of the patient's condition e.g. compliance with current therapies.
Reassess at any time if symptoms worsen rapidly or significantly taking account of:
Course length based on an assessment of the severity of bronchiectasis, exacerbation history, severity of exacerbation symptoms, previous culture and susceptibility results, and response to treatment.
(including pregnancy)
People who may be at higher risk of treatment failure include people who have had repeated courses of antibiotics, a previous sputum culture with resistant or atypical bacteria, or a higher risk of developing complications.
If co-amoxiclav is not suitable, seek specialist advice to discuss the use of fluoroquinolones.
See section 5.1.1 Penicillins, 5.1.3 Tetracyclines, and 5.1.5 Macrolides
Course length based on an assessment of the severity of bronchiectasis, exacerbation history, severity of exacerbation symptoms, previous culture and susceptibility results, and response to treatment.
Amoxicillin is the preferred choice in young women who are pregnant
People who may be at higher risk of treatment failure include people who have had repeated courses of antibiotics, a previous sputum culture with resistant or atypical bacteria, or a higher risk of developing complications.
If co-amoxiclav is not suitable, seek specialist advice to discuss the use of fluoroquinolones.
See section 5.1.1 Penicillins, 5.1.3 Tetracyclines, and 5.1.5 Macrolides
Do not routinely offer antibiotic prophylaxis to prevent acute exacerbations of bronchiectasis. Give advice about seeking medical help if symptoms of an acute exacerbation develop.
Seek specialist advice about options for preventing exacerbations in people with repeated acute exacerbations, which may include a trial of antibiotic prophylaxis.
Consider (re)referral to specialist clinic for review of physiotherapy/mucolytics and/or prophylactic antibiotics in the following indications: