Anti-microbial treatment in bronchiectasis

Lucy Morgan
Macquarie University, New South Wales, Australia

Antimicrobial therapy is a cornerstone in the management of bronchiectasis, particularly during acute exacerbations and in patients with chronic bacterial colonization. Exacerbations are frequently triggered by bacterial infections, with Pseudomonas aeruginosa, Haemophilus influenzae, among the most common pathogens.

Timely and appropriate antibiotic therapy improves symptom control, reduces exacerbation frequency, and slows disease progression. Treatment is ideally guided by sputum microbiology, with consideration of prior culture results and antibiotic sensitivities. Oral, inhaled, or intravenous antibiotics may be used depending on severity, pathogen, and patient response.

The antibiotic regimes require careful selection and monitoring due to risks of antimicrobial resistance, side effects, and QT prolongation. Antibiotic stewardship is critical to balance the need for effective therapy with the risk of resistance development. Optimizing antimicrobial use is essential in reducing disease burden, improving quality of life, and preserving antibiotic efficacy for the future.