Modification and duration of therapy for M. catarrhalis bronchiectasis exacerbations in adults

Review the results of culture and susceptibility testing, and the response to initial therapy for M. catarrhalis bronchiectasis exacerbations in adults. Seek expert advice if methicillin-resistant Staphylococcus aureus (MRSA), nontuberculous mycobacteria, Aspergillus species or other less common drug-resistant organisms (eg Achromobacter species, Stenotrophomonas maltophilia) are isolated in sputum samples taken for cultureChang, 2023Visser, 2018.

If adults with an exacerbation of bronchiectasis are improving, adjustment of antibiotic therapy based on the results of sputum culture and susceptibility testing is not requiredChang, 2023Hill, 2019Visser, 2018.

If the patient was treated with intravenous antibiotic therapy and is clinically improving, consider switching to oral therapy (see Guidance for intravenous to oral switch for guidance on when to switch to oral therapy). For regimens, see oral antibiotic therapy.

Ensure other aspects of bronchiectasis management are optimised, such as airway clearance, physical activity and, if appropriate, bronchodilator therapy (see Management of bronchiectasis).

Note: Optimise airway clearance, physical activity and, if appropriate, bronchodilator therapy during exacerbations of bronchiectasis.

If the patient is not improving with initial antibiotic therapy, modify treatment based on the results of sputum culture and susceptibility testing1Hill, 2019. Consider intravenous therapy for those who do not improve on oral therapy.

Data to guide the optimal duration of therapy are limitedWurzel, 2011; expert consensus is to treat exacerbations of bronchiectasis for 14 days (intravenous + oral)Chang, 2023Hill, 2019Polverino, 2017. If clinical response is rapid in an adult with an M. catarrhalis bronchiectasis exacerbation, it is reasonable to shorten the duration of therapy to 10 days (intravenous + oral)Hill, 2019Polverino, 2017.

Refer adults who do not respond to antibiotic therapy and those who have 3 or more bronchiectasis exacerbations per year to a respiratory physicianChang, 2023. Management decisions should be discussed with the treating respiratory specialist and guided by an individualised bronchiectasis management plan.

1 Gram stain of poor-quality sputum samples can give misleading results. Use a good-quality sample (presence of polymorphs but few or no squamous epithelial cells on microscopy), collected before starting antibiotics, to adjust antibiotic therapy – the pathogen should be predominant in the Gram stain as well as the culture.Return