Infectious Disease Compendium

Bronchiectasis

Diagnosis

Dilations/destruction of the airway. They become colonized with a wide variety of bacteria, mycobacteria, and molds. A spiral of chronic infection that leads to more destruction and inflammation.

Patients are miserable with a chronic productive cough (PubMed).

Epidemiologic Risks

Smoking and cystic fibrosis.

Microbiology

Anything can colonize and the microbiology can change as underlying disease progresses and the bugs evolve resistance.

Pseudomonas, MAI and other non-TB mycobacteria and Aspergillus are particular problems.

Empiric Therapy

Depends on what grows. Antibiotics are most beneficial for acute exacerbations. As with all chronic conditions, there are guidelines.

In non-CF bronchiectasis, the daily azithromycin results in a lower rate of infectious exacerbations compared to placebo. This could result in better quality of life and might influence survival, although 88% developed antibiotic resistance (PubMed).

Most acute exacerbations are treated with a 14 day course of antibiotics, although no good data to suggest shorter course are worse.

These patients often received prolonged courses of inhaled aminoglycosides with some benefit.

Long term antibiotics (inhaled aminoglycosies or po macrolides) are often given to patients with recurrent exacerbations (three a year or more).

Pearls

RA patients treated with biologics have increased rates of pneumonia (PubMed).

Lung transplants are one of the treatments.

Rants

These patients often receive prolonged antibiotics; a classic example of short term benefit with the development of long term resistance.

All the recommendations for treatment have at best moderate quality evidence.

Last Update: 05/27/18.