Table 6

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

OrganismRecommended first-line treatmentLength of treatment (days)Recommended second-line treatmentLength of treatment (days)
Streptococcus
pneumoniae
Amoxicillin
500 mg three times a day
14Doxycycline 100 mg twice a day14
Haemophilus influenzae—beta lactamase negativeAmoxicillin
500 mg three times a day
or
Amoxicillin
1 g three times a day
or
Amoxicillin
3 g twice a day
14Doxycycline 100 mg twice a day
or
Ciprofloxacin
500 mg or 750 mg twice a day
or
Ceftriaxone 2 g once a day (intravenous)
14
Haemophilus influenzae—beta lactamase positiveAmoxicillin with clavulanic
acid 625 mg 1 tablet three times a day
14Doxycycline
100 mg twice a day
or
Ciprofloxacin
500 mg or 750 mg twice a day
or
Ceftriaxone 2 g once a day (intravenous)
14
Moraxella catarrhalis Amoxicillin with clavulanic
acid 625 mg 1 tablet three times a day
14Clarithromycin 500 mg twice a day
or
Doxycycline 100 mg twice a day
or
Ciprofloxacin
500 mg
or 750 mg twice a day
14
Staphylococcus aureus (MSSA)Flucloxacillin 500 mg four times a day14Clarithromycin 500 mg twice a day
or
Doxycycline 100 mg twice a day
or
Amoxicillin with clavulanic acid 625 mg 1 tablet three times a day
14
Staphylococcus aureus (MRSA) oral preparationsDoxycycline 100 mg twice a dayRifampicin (<50 kg) 450 mg
once a day
Rifampicin (>50 kg) 600 mg once a day
Trimethoprim 200 mg twice a day
14Third-line linezolid 600 mg twice a day14


Staphylococcus aureus (MRSA) intravenous preparationsVancomycin 1 g twice a day* (monitor serum levels and adjust dose accordingly) or teicoplanin 400 mg once a day14Linezolid 600 mg twice a day14
Coliforms, eg, Klebsiella, Enterobacter Oral ciprofloxacin 500 mg or 750 mg twice a day14Intravenous ceftriaxone 2 g once a day14
Pseudomonas aeruginosa Oral ciprofloxacin 500 mg twice a day (750 mg twice a day in more severe infections)14

Monotherapy:
intravenous ceftazidime 2 g three times a day
or
piperacillin with tazobactam 4.5 g three times a day
or
aztreonam 2 g three times a day
or
meropenem 2 g three times a day
­
Combination therapy:
the above can be combined with gentamicin or tobramycin or
colistin 2 mU three times a day (under 60 kg, 50 000–75 000 U/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
  • 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 BNF 72 (March 2017).

  • IV, intravenous; MRSA, methicillin-resistant S.aureus; MSSA, methicillin-susceptible Staphylococcus aureus.