Bronchiectasis, part 2: Management

Systemic antibiotics are the mainstay of the management of acute exacerbations of bronchiectasis. Antibiotic selection should include coverage for Streptococcus pneumoniae and Haemophilus influenzae; particular attention also should be paid to the presence of Staphylococcus aureus and Pseudomonas species. The duration of antibiotic therapy is not well-established, but most clinicians recommend a prolonged course, often longer than 3 weeks. There is some evidence that long-term low-dose macrolide therapy can reduce the incidence of acute exacerbations and decrease sputum production. There also may be a role for the use of inhaled antibiotics. Airway clearance strategies, such as chest percussion and postural drainage, are clearly useful in patients with cystic fibrosis and may be useful in other patients with bronchiectasis. Surgical resection can be considered if a patient has localized disease that is refractory to medical management or if he/she is unwilling to undergo long-term medical therapy.