CRA46 A DECADE OF EVOLUTION: MANAGING CHRONIC BRONCHIECTASIS WITH AZITHROMYCIN AND NEBULIZED GENTAMICIN AFTER CIPROFLOXACIN RESISTANCE

Kit Yeng Toh¹, Dr. Nizafaziasyida Fauzee Andylim²

¹ Hospital Sultan Haji Ahmad Shah, Temerloh
² Hospital Tengku Ampuan Afzan, Kuantan

Introduction
Chronic bronchiectasis is characterized by recurrent infections and exacerbations. This case explores a decade of treatment evolution in a patient with non-cystic fibrosis bronchiectasis, transitioning from ciprofloxacin to azithromycin and nebulized gentamicin after Pseudomonas aeruginosa resistance to ciprofloxacin was observed. The use of azithromycin and inhaled gentamicin aligns with the British Thoracic Society (BTS) guidelines and is tailored to bacterial sensitivity to gentamicin.

Case Report
A 48-year-old male with Marfan’s syndrome, post-tuberculosis bronchiectasis and post-lobectomy was initially treated with erythromycin and cyclical ciprofloxacin, which led to resistance after 3 years. Treatment was adjusted to azithromycin 250 mg thrice weekly and nebulized gentamicin 80 mg twice daily, with Ambroxol as mucolytic. Up-to-date influenza vaccine and pneumococcal vaccine was given. The patient expressed confidence in treatment reporting significant reduction in symptoms including reduced hemoptysis, exacerbations and with only one hospitalisation over the past 9 years after the change of treatment. Ciprofloxacin sensitivity was regained, and no pathogens were detected in sputum cultures since 2023. Regular monitoring showed stable full blood counts, liver and renal function, and normal audiogram. CT scans revealed chronic lung changes without significant progression indicating stable disease over time.

Discussion
Azithromycin’s anti-inflammatory effects and ability to disrupt Pseudomonas aeruginosa biofilms enhanced the effectiveness of nebulized gentamicin in reducing bacterial load and inflammation.

Conclusion
This case demonstrates that individualised treatment with azithromycin and nebulized gentamicin are effective in managing chronic respiratory infections in bronchiectasis. Multidisciplinary collaboration is crucial in ensuring efficacy and safety through proper medication use, adverse drug effects and drug interaction monitoring, education on nebulizer technique and adherence.