Opinion
Video
Unmet Needs for Bronchiectasis Exacerbations
Panelists discuss how reducing bronchiectasis exacerbations requires standardized definitions, tailored antibiotic approaches, and increased airway clearance, while addressing underlying conditions and ongoing research into optimal treatment protocols.
Clinical Brief: Antibiotic Management in Bronchiectasis Exacerbations
Main Discussion Topics
- Antibiotics are a key component of exacerbation management and sometimes chronic therapy.
- Antibiotic selection should be guided by regular sputum cultures and patient history.
- Patient education about exacerbation recognition is crucial for timely intervention.
Key Points for Physicians
- Implement bronchiectasis action plans to help patients recognize exacerbation symptoms.
- Encourage regular sputum sample collection to guide antibiotic selection.
- Consider chronic, suppressive inhaled antibiotics for Pseudomonas aeruginosa.
- Monitor for nontuberculous mycobacterial (NTM) infection, especially in patients on chronic macrolides.
- In select patients, provide antibiotic “rescue packs” for patient-initiated treatment of exacerbations.
Notable Insights
Chronic macrolide therapy is often used for immunomodulatory and anti-inflammatory effects rather than antimicrobial properties but requires careful monitoring for development of NTM resistance.
Clinical Significance
A balanced approach to antibiotic management includes appropriate acute treatment of exacerbations, selective use of chronic suppressive therapy, and vigilant monitoring to prevent resistance.
