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

Review the results of culture and susceptibility testing, and the response to initial therapy for M. catarrhalis bronchiectasis exacerbations in children.

If children 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 child 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.

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

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, 2023Chang, 2021. If clinical response is rapid (eg cough resolved by day 7) in a child with a M. catarrhalis bronchiectasis exacerbation, it is reasonable to shorten the duration of therapy to 10 days (intravenous + oral)Chang, 2023.

If the child has not improved after 14 days of antibiotic therapy, refer to the treating specialist for consideration of extended therapy or a change to intravenous therapy.

Refer all children with bronchiectasis to a paediatric specialist. Children with frequent exacerbations should have regular specialist and physiotherapist review. Management decisions should be discussed with the treating specialist and guided by the child’s individualised bronchiectasis management plan.