Principles of antibiotic therapy for bronchiectasis exacerbations in children
This topic focuses on antibiotic management of children with exacerbations of bronchiectasis.
- For causes, clinical features, diagnosis and general management of bronchiectasis, see Bronchiectasis in the Respiratory guidelines.
- For management of airway infection in cystic fibrosis, see Airway infection and antibiotic therapy in cystic fibrosis in the Respiratory guidelines.
Refer children with suspected or confirmed bronchiectasis to a paediatric specialist for diagnosis and ongoing management.
An exacerbation of bronchiectasis in children is an acute deterioration of respiratory symptoms (eg wet-sounding cough with or without increased sputum quantity or purulence) from the child’s baseline that usually develops over 3 daysChang, 2021. Children with bronchiectasis may have airways colonised with bacteria such as Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis; colonisation with Pseudomonas aeruginosa or Staphylococcus aureus is less common in children than adultsChang, 2021Polverino, 2017. Exacerbations of bronchiectasis may be caused by colonising organisms and/or infection with a new organism, including common respiratory viruses (eg coronaviruses, rhinoviruses, influenza A or B).
For clinically stable children with bronchiectasis, do not use antibiotic therapy to treat most colonising organisms (P. aeruginosa is the exception – seek specialist advice). Consider antibiotic therapy for children with any of the clinical features listed in Clinical features of an exacerbation of bronchiectasis in children that require antibiotic therapyChang, 2021. Consider chest X-ray for more severe exacerbations or to exclude lobar collapse due to mucous impactionChang, 2020.
Consider antibiotic therapy for children with an exacerbation of bronchiectasis who have any of the following clinical features:
- increased wet-sounding cough, with or without increased sputum quantity or purulence, for 3 days or longer
- wheeze, breathlessness or haemoptysis (less common)
- increased work of breathing or hypoxia.
Consider performing a nose and throat or nasopharyngeal swab1 for nucleic acid amplification testing (NAAT) (eg polymerase chain reaction [PCR]) for influenza and other respiratory viruses if clinically indicatedGao, 2015Hill, 2019.
If possible, collect a sputum sample for culture and susceptibility testing before starting antibiotic therapy2 for bronchiectasis exacerbations in children. Younger children (eg 6 years or younger) are often unable to expectorate sputum; however, most older children in the community can expectorate sputum.
While awaiting the results of investigations, start empirical antibiotic therapy. The results of sputum culture and susceptibility testing are used to modify therapy in children who are not improving on empirical antibiotic therapy. If the child is improving, adjustment of antibiotic therapy is not requiredChang, 2021, unless P. aeruginosa is identified on the first occasion (see Approach to antibiotic therapy for bronchiectasis exacerbations in children with Pseudomonas aeruginosa).
When the results of sputum culture and susceptibility testing are available, direct antibiotic therapy accordingly. Regimens are included in this topic for:
- Haemophilus influenzae bronchiectasis exacerbations in children
- Moraxella catarrhalis bronchiectasis exacerbations in children
- Streptococcus pneumoniae (pneumococcal) bronchiectasis exacerbations in children
- Pseudomonas aeruginosa bronchiectasis exacerbations in children.
The role of long-term antibiotic therapy for bronchiectasis in children is the same as in adults – see The role of long-term oral or inhaled antibiotic therapy for bronchiectasis in adults.