Treatment indicated if there are signs of infection e.g.
- change in sputum colour/volume,
- increased dyspnoea
- increased cough
- increased wheeze
- change in clinical signs.
Sputum culture essential to identify causative organism
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
No previous microbiology:
or PO clarithromycin
(should not be used in patients receiving treatment long term with azithromycin)
P.aeruginosa colonisation: PO ciprofloxacin
Refer to CKS Bronchiectasis Scenario: Infective exacerbation Table 1
discuss with microbiologist.