Meeta Prasad, MD

Systemic antibiotics are the mainstay of the managementof acute exacerbations of bronchiectasis. Antibiotic selection should include coverage for Streptococcus pneumoniaeand Haemophilus influenzae; particular attention alsoshould be paid to the presence of Staphylococcus aureus andPseudomonas species. There is some evidence that long-termlow-dose macrolide therapy can reduce the incidence of acuteexacerbations and decrease sputum production. There alsomay be a role for the use of inhaled antibiotics in the treatmentof bronchiectasis. Airway clearance strategies, such as chestpercussion and postural drainage, are clearly useful in patientswith cystic fibrosis and may be useful in managing bronchiectasisin other patients. Surgical resection can be considered if apatient has localized disease that is refractory to medical managementor if he or she is unwilling to undergo long-term medicaltherapy. (J Respir Dis. 2008;29(1):20-25)