Treatment indicated if there are signs of infection e.g.

  • change in sputum colour/volume,
  • increased dyspnoea
  • increased cough
  • fever
  • increased wheeze
  • fatigue
  • change in clinical signs.

Sputum culture essential to identify causative organism and monitor antibiotic resistance. 

Initial treatment following sputum culture: previous cultures and sensitivities should guide antibiotic choice.

  • Review the response to empirical treatment when sputum culture and sensitivity results are available.:
  • If good response, continue with the prescribed antibiotic + do not change the treatment based on the culture results.
  • If poor or no response, prescribe a different antibiotic, guided by the results of sputum culture and sensitivity testing.

Consider bronchodilators and ensure expectoration techniques are being carried out. Home antibiotic therapy (IV or nebulised) or long term azithromycin therapy should only be commenced after consultation with Respiratory Physician.

If clinical failure despite two courses of different classes of antibiotic - discuss with Respiratory team.

First choice empirical antibiotics:


500mg TDS

7-14 Days

or Clarithromycin

(do not use if on long-term azithromycin already)

500mg BD

7-14 Days

or Doxycycline

200mg on Day 1 then 100mg OD

7-14 days

Pseudomonas colonisation: 

First choice empirical antibiotic (as above)

7-14 days

Pseudomonas colonisation and clinical failure on first choice antibiotic:




750mg BD

7-14 days

Other organisms (e.g. Haemophilus influenzae, Staph aureus):

Refer to CKS Bronchiectasis Scenario: Infective exacerbation Table 1


or discuss with consultant microbiologist.