Oral therapy for S. pneumoniae (pneumococcal) bronchiectasis exacerbations in adults

If S. pneumoniae is isolated in the sputum sample of an adult with a bronchiectasis exacerbation, useChang, 2023:

amoxicillin 1 g orally, 8-hourly; see advice on modification and duration of therapy. For dosage adjustment in adults with kidney impairment, see amoxicillin dosage adjustment. amoxicillin amoxicillin amoxicillin

For adults who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin1, use:

cefuroxime 500 mg orally, 12-hourly; see advice on modification and duration of therapy. For dosage adjustment in adults with kidney impairment, see cefuroxime dosage adjustment. cefuroxime cefuroxime cefuroxime

For adults who have had a severe (immediate or delayed)2 hypersensitivity reaction to a penicillin, use the results of susceptibility testing to guide therapy. While awaiting results, use:

1doxycycline 100 mg orally, 12-hourly; see advice on modification and duration of therapy doxycycline doxycycline doxycycline

OR

2moxifloxacin 400 mg orally, daily; see advice on modification and duration of therapy. For dosage adjustment in adults with kidney impairment, see moxifloxacin dosage adjustment. moxifloxacin moxifloxacin moxifloxacin

1 For patients with severe immediate penicillin hypersensitivity who tolerated ceftriaxone, it is safe to use cefuroxime.Return
2 Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return