Oral therapy for bronchiectasis exacerbations in children with P. aeruginosa colonisation

Oral ciprofloxacin is recommended if P. aeruginosa is isolated in the respiratory sample of a child with a bronchiectasis exacerbation who has known P. aeruginosa colonisation1 – if P. aeruginosa is newly identified, refer the child to a respiratory physician for eradication therapy.

Before prescribing ciprofloxacin for a child with a bronchiectasis exacerbation and known P. aeruginosa colonisation, consult the child’s respiratory physician or bronchiectasis management planChang, 2021. While awaiting expert advice, regardless of susceptibility results, a suitable regimen is:

ciprofloxacin 20 mg/kg up to 750 mg orally, 12-hourly; see below for advice on modification and duration of therapy23. ciprofloxacin

Review the results of culture and susceptibility testing, and the response to initial therapy. Data to guide the optimal duration of therapy are limitedWurzel, 2011; expert consensus is to treat exacerbations of bronchiectasis caused by P. aeruginosa for 14 daysChang, 2023Chang, 2021. If clinical response is rapid, it is reasonable to shorten the duration of therapy to 10 daysHill, 2019Polverino, 2017.

For children who have not improved on oral therapy for P. aeruginosa bronchiectasis exacerbations, ensure other aspects of bronchiectasis management are optimised (eg airway clearance, physical activity and, if appropriate, bronchodilator therapy – see Management of bronchiectasis) and consider intravenous therapyChang, 2023.

1 A suggested definition of colonisation with P. aeruginosa is 2 positive culture results of respiratory samples, at least 3 months apart, within the past 12 months.Return
2 An oral liquid formulation of ciprofloxacin is not commercially available; for formulation options for children or people with swallowing difficulties, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return
3 Ciprofloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, clinical trial data suggest that adverse musculoskeletal events are usually mild and short term, similar to those observed in adults. Ciprofloxacin can be used in children when it is the drug of choice.Return