From the Guidelines
The treatment of an acute flare of bronchiectasis should focus on controlling infection, improving airway clearance, and managing symptoms, with antibiotics as the cornerstone of therapy, typically including amoxicillin-clavulanate 875/125 mg twice daily, doxycycline 100 mg twice daily, or levofloxacin 750 mg daily for 14 days, as recommended by the British Thoracic Society guideline for bronchiectasis in adults 1.
Key Components of Treatment
- Antibiotics: The choice of antibiotic should be guided by previous sputum cultures when available, and empiric coverage should include common pathogens such as Haemophilus influenzae and Pseudomonas aeruginosa 1.
- Airway clearance techniques: Postural drainage, chest physiotherapy, and devices like oscillating positive expiratory pressure (PEP) devices (such as Acapella or Flutter) are essential for improving mucus clearance 1.
- Bronchodilators: Albuterol 2.5 mg via nebulizer or 2 puffs via MDI every 4-6 hours can help with bronchospasm 1.
- Oral corticosteroids: A short course of prednisone 40 mg daily for 5-7 days may be beneficial for patients with significant inflammation 1.
- Hydration: Adequate hydration is important to thin secretions, aiming for 2-3 liters of fluid daily 1.
- Oxygen supplementation: Oxygen should be provided if hypoxemia is present 1.
Preventive Strategies
- Inhaled antibiotics: Inhaled colistin, gentamicin, and azithromycin have been shown to reduce exacerbation rates and improve quality of life in patients with bronchiectasis and chronic P. aeruginosa infection 1.
- Long-term antibiotic treatment: Long-term antibiotic treatment may be beneficial for patients with three or more exacerbations per year, as recommended by the European Respiratory Society guidelines for the management of adult bronchiectasis 1.
Important Considerations
- The goal of treatment is to reduce bacterial load, improve mucus clearance, and decrease airway inflammation, which collectively helps resolve symptoms and prevent further lung damage 1.
- Preventive strategies should be implemented to reduce future exacerbations, including inhaled antibiotics and long-term antibiotic treatment 1.
- The treatment approach should be individualized based on the patient's specific needs and circumstances, taking into account factors such as the severity of the exacerbation, the presence of comorbidities, and the patient's response to previous treatments 1.
From the Research
Acute Flare of Bronchiectasis Treatment
- The treatment of acute flares of bronchiectasis typically involves the use of antibiotics, as they are an essential component of managing patients with bronchiectasis 2.
- Studies have shown that oral amoxicillin-clavulanate and azithromycin are effective in resolving non-severe exacerbations in children with bronchiectasis 3, 4.
- Amoxicillin-clavulanate is often recommended as the first-line empirical oral antibiotic treatment for non-severe exacerbations in children with bronchiectasis, but azithromycin can be considered as an alternative option in certain cases, such as penicillin hypersensitivity or poor adherence 3.
- A randomized controlled trial found that azithromycin is non-inferior to amoxicillin-clavulanate for resolving exacerbations in children with non-severe bronchiectasis, but exacerbations were significantly shorter in the amoxicillin-clavulanate group 3.
- Another study found that amoxicillin-clavulanate treatment is beneficial in terms of resolution of non-severe exacerbations of bronchiectasis in children, and should remain the first-line oral antibiotic in this setting 4.
- Treatment decisions for pulmonary exacerbations and their prevention should be based on individual patient needs and circumstances, taking into account factors such as the severity of the exacerbation, the presence of underlying conditions, and the risk of antibiotic resistance 5.