Antibiotics are commonly used in people with bronchiectasis to treat recurrent lung infections. They are used to treat and prevent exacerbations, and to reduce the number of bacteria that are present in the lungs.
Apart from the recommended physical therapy and inhaled fluticasone that may reduce inflammation and improve airway obstruction, some people may need a prolonged use of oral antibiotics for bronchiectasis because of repeat exacerbations or flares.2 Antibiotics can also be inhaled using a nebulizer.
Sometimes, the lungs of people with bronchiectasis are chronically infected by bacteria that thrive in mucus. Due to the thickening and scarring of the airway wall that is typical of bronchiectasis, the effectiveness of antibiotic treatment outcome may be compromised. More severe infections or those in people who are clinically unwell or don’t respond to oral antibiotics may need antibiotics given intravenously and possibly in a hospital setting.
One of the most difficult bacterium to treat is Pseudomonas aeruginosa. It is resistant to most antibiotics at normal dosages.
Studies of antibiotic use in bronchiectasis treatment
Five studies regarding a prolonged use of antibiotics in purulent bronchiectasis were positive regarding antibiotics that affected the volume and number of bacteria in sputum. Azithromycin decreased the number of exacerbations compared with usual care, while gentamicin inhaled twice a day for three days improved the production of sputum, the infection, the airway obstruction, and the exercise capacity. Inhaled tobramycin twice a day for four weeks removed Pseudomonas aeruginosa in 35% of a group of participants and improved the condition in 62% of patients in these studies. Inhaled ceftazidime and tobramycin twice a day for 12 months decreased the number of hospital admissions and length of hospital stay.
Antibiotic treatment in bronchiectasis flares
People with bronchiectasis may cough up considerable amounts of sputum even when they are well. So, it is important to identify exacerbations, or flares, when they occur to begin appropriate treatment.
Oral antibiotics currently in use to treat acute exacerbations of bronchiectasis in adults are amoxicillin, 500–1,000 mg three times a day for Streptococcus pneumoniae and Haemophilus influenzae; co-amoxiclav, 625 mg three times a day, for Moraxella catarrhalis; flucloxacillin, 500–1,000 mg four times a day, for Staphylococcus aureus; rifampicin, 400–600 mg once daily, fucidin, 500 mg three times a day, and ciprofloxacin, 750 mg twice a day, for Pseudomonas aeruginosa and coliforms (a rod-shaped bacteria normally present in the intestine).
Intravenous antibiotics may be required in severe cases, or where oral use fails to treat an acute exacerbation. IV antibiotics currently in use for such cases are benzylpenicillin, 1.2 g four times a day, for Streptococcus pneumoniae; cefuroxime 1.5 g three times a day, or ceftriaxone 2 g once daily, for Haemophilus influenzae and Moraxella catarrhalis’ vancomycin for MRSA; ceftazidime, 2 g three times a day, for Pseudomonas aeruginosa; and cefuroxime 1.5 g three times a day for coliforms.
Long-term antibiotics for bronchiectasis
Long-term antibiotics are used in people with bronchiectasis to improve disease symptoms, decrease exacerbation rates, and improve quality of life. These include amoxicillin, 500 mg twice daily, for Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis; flucloxacillin, 500–1,000 mg twice a day, for Staphylococcus aureus; and trimethoprim 200 mg twice daily for MRSA.
Future antibiotic treatment strategies
Antibiotic treatment for people with bronchiectasis may change, as interest in inhaled forms of the treatment as an alternative to oral antibiotics grows. Newer nebulized (amikacin, aztreonam, colistin, and fosfomycin with tobramycin) and dry powder (ciprofloxacin, colistin, and tobramycin) forms have been developed that may benefit these patients.
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