What are the alternative antibiotic treatments for non-cystic fibrosis (NCFB) bronchiectasis patients who have failed treatment with Ciprofloxacin (ciprofloxacin)?

From the Guidelines

For patients with non-cystic fibrosis bronchiectasis who have failed ciprofloxacin treatment, the most effective alternative antibiotic option is inhaled colistin, as recommended by the British Thoracic Society guideline for bronchiectasis in adults 1. This recommendation is based on the guideline's suggestion to use inhaled colistin for patients with bronchiectasis and chronic Pseudomonas aeruginosa infection.

• Inhaled gentamicin can be considered as a second-line alternative to colistin for patients with bronchiectasis and chronic P. aeruginosa infection 1.
• Azithromycin or erythromycin can be considered as an alternative or additive treatment to an inhaled antibiotic for patients with bronchiectasis and chronic P. aeruginosa infection, especially for those who do not tolerate inhaled antibiotics or have a high exacerbation frequency 1.
• It is essential to review the patient's culture and mycobacterial status, optimize airway clearance, and treat other associated conditions before starting long-term antibiotics 1.
• Patients should be monitored for clinical improvement, including reduced sputum production, improved color, decreased cough, and resolution of systemic symptoms, and for potential major side effects of long-term antibiotics 1.
• The choice of antibiotic should be guided by sputum culture results whenever possible to target specific pathogens like Pseudomonas aeruginosa, Haemophilus influenzae, or Moraxella catarrhalis 1.
• Airway clearance techniques, bronchodilators, and addressing underlying causes remain essential components of comprehensive management 1.

From the Research

Antibiotic Treatment in Non-Cystic Fibrosis Bronchiectasis Failing Ciprofloxacin

• The use of inhaled ciprofloxacin in non-cystic fibrosis bronchiectasis (NCFB) has been investigated in several studies, with results showing that it can significantly prolong the time to first exacerbation, reduce the frequency of exacerbations, and decrease sputum Pseudomonas aeruginosa density 2.
• However, there is limited information available on alternative antibiotic treatments for NCFB patients who fail ciprofloxacin treatment.
• According to a review article, antibiotic treatment of exacerbations is a cornerstone medicinal treatment in bronchiectasis management, and patients with frequent exacerbations can be considered for long-term low-dose macrolide treatment 3.
• Another study suggests that inhaled antibiotics might be beneficial in selected patients colonized with Pseudomonas aeruginosa 3.
• A review of non-cystic fibrosis bronchiectasis management highlights the importance of individualized therapy and follow-up, including monitoring of symptoms and screening for bacterial colonization 4.
• The use of prolonged-use antibiotics may improve clinical response rates, but may not reduce exacerbation rates or lung function 5.

Alternative Treatment Options

• Long-term low-dose macrolide treatment may be considered for patients with frequent exacerbations 3.
• Inhaled antibiotics, such as inhaled ciprofloxacin, may be beneficial in selected patients colonized with Pseudomonas aeruginosa 3, 6.
• Surgery may be considered for people with extreme damage to one or two lobes of the lung who are at risk for severe infection or bleeding 5.