# Bronchiectasis (Non-CF Exacerbation & Suppression) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: BTS Guideline for Bronchiectasis in Adults 2019 - Verified date: 2026-08 ## Verified against - BTS Guideline for Bronchiectasis in Adults 2019 - Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) - Bronchiectasis - disease-level clinical article (bronchiectasis-clinical.txt) ## Treatment metadata - Amoxicillin + Clavulanic acid — 1000 mg — oral.solid - Ciprofloxacin — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - Azithromycin — 250 mg — oral.solid ## Complete treatment card ```text BRONCHIECTASIS (NON-CF EXACERBATION & SUPPRESSION) Sources: BTS Guideline for Bronchiectasis in Adults 2019 Review status: REVIEWED against BTS Guideline for Bronchiectasis in Adults 2019, Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph), Bronchiectasis - disease-level clinical article (bronchiectasis-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - A long history of a chronic, productive cough with purulent sputum is typical [cough · sputum] - Recurrent chest infections needing antibiotics over several years are commonly reported - Progressive breathlessness, intermittent wheeze, coughing up blood, and pleuritic pain can occur, with fatigue and weight loss [breathlessness · chest pain · coughing up blood · fatigue · weight loss · wheeze] - Blood-streaked purulent sputum is usually mild, though it can rarely become life-threatening [sputum] - Cough is reported in about 98% of patients and sputum production in about 78% [cough · sputum] - A flare-up shows increased sputum, breathlessness, cough, wheeze, and fever, with reduced lung function [breathlessness · cough · fever · sputum · wheeze] SIGNS - what you find (5) - General exam findings are nonspecific - Digital clubbing occurs in only about 2% to 3% of patients, alongside cyanosis, plethora, and wasting [cyanosis · finger clubbing · muscle wasting] - Chest auscultation most often reveals crackles and wheezes [crackles] - Crackles, usually heard at both lung bases, are found in about 75% of patients [crackles] - Wheezing is heard in about 22%, from airflow obstruction by secretions [wheeze] TESTS (9) - Immunoglobulin testing (IgA, IgM, IgG, IgE) is checked to look for an underlying cause - ABPA is excluded with Aspergillus-specific IgE, Aspergillus IgG, and an eosinophil count - Cystic fibrosis testing (sweat test or common mutation screening) is done under age 40, or with recurrent Pseudomonas or Staph infection, or upper-lobe disease at any age - Chest x-ray is usually the first imaging test ordered - X-ray can show parallel line shadows, tram-track opacities, or ring shadows from thickened, dilated bronchial walls - CT is more sensitive and specific than chest x-ray and can narrow the differential to a few causes - The hallmark CT sign is bronchial dilation, defined by a broncho-arterial ratio over 1 - On CT, airways visible within 1 cm of the pleural surface indicate bronchiectasis - Spirometry shows a fall in FEV1 from airflow obstruction and a rise in residual volume from air trapping IF NOT THIS - what else fits (4) - Alpha-1 antitrypsin deficiency and aspiration pneumonitis or pneumonia are considered - Asthma, bronchitis, and COPD are also on the differential - Cystic fibrosis and emphysema are further considerations - GERD and tuberculosis round out the differential list Source StatPearls "Bronchiectasis" - disease-level clinical article Status traced to the source above Rx: Exacerbation - first line | If Pseudomonas isolated | Main treatment EXACERBATION - FIRST LINE 1. AMOXICILLIN + CLAVULANIC ACID [1st line] Adult 875/125 mg twice daily or 500/125 mg three times daily for 10-14 days during acute exacerbation x 10-14 days Peds 40-45 mg/kg/day [child max 1750 mg] (Of amoxicillin component divided BID for 10-14 days under pediatric pulmonology supervision. Ceiling of 1750 mg/day is the Egyptian National Drug Formulary maximum for the 7:1 formulation; the BTS guideline is an adults document and sets no pediatric limit.) 3kg -> 120-135 mg/day 4kg -> 160-180 mg/day 5kg -> 200-225 mg/day 6kg -> 240-270 mg/day 7kg -> 280-315 mg/day 8kg -> 320-360 mg/day 9kg -> 360-405 mg/day 10kg -> 400-450 mg/day 11kg -> 440-495 mg/day 12kg -> 480-540 mg/day 13kg -> 520-585 mg/day 14kg -> 560-630 mg/day 15kg -> 600-675 mg/day 16kg -> 640-720 mg/day 17kg -> 680-765 mg/day 18kg -> 720-810 mg/day 19kg -> 760-855 mg/day 20kg -> 800-900 mg/day 21kg -> 840-945 mg/day 22kg -> 880-990 mg/day 23kg -> 920-1035 mg/day 24kg -> 960-1080 mg/day 25kg -> 1000-1125 mg/day 26kg -> 1040-1170 mg/day 27kg -> 1080-1215 mg/day 28kg -> 1120-1260 mg/day 29kg -> 1160-1305 mg/day 30kg -> 1200-1350 mg/day 31kg -> 1240-1395 mg/day 32kg -> 1280-1440 mg/day 33kg -> 1320-1485 mg/day 34kg -> 1360-1530 mg/day 35kg -> 1400-1575 mg/day 36kg -> 1440-1620 mg/day 37kg -> 1480-1665 mg/day 38kg -> 1520-1710 mg/day 39kg -> 1560-1750 mg/day (upper capped) 40kg -> 1600-1750 mg/day (upper capped) 41kg -> 1640-1750 mg/day (upper capped) 42kg -> 1680-1750 mg/day (upper capped) 43kg -> 1720-1750 mg/day (upper capped) 44kg -> 1750 mg/day (capped) 45kg -> 1750 mg/day (capped) 46kg -> 1750 mg/day (capped) 47kg -> 1750 mg/day (capped) 48kg -> 1750 mg/day (capped) 49kg -> 1750 mg/day (capped) 50kg -> 1750 mg/day (capped) Source BTS Guideline for Bronchiectasis in Adults 2019 Why Broad-spectrum penicillin and beta-lactamase inhibitor combination used to treat an acute bronchiectasis exacerbation, targeting the typical respiratory pathogens found in these damaged airways; paired with chest physiotherapy rather than used alone. Caution CONTRAINDICATED in penicillin/beta-lactam hypersensitivity and in history of co- amoxiclav-associated jaundice or hepatic dysfunction. Obtain sputum culture and sensitivity prior to starting antibiotics whenever possible (review against prior microbiology). Longer duration (10-14 days) is required compared to uncomplicated bronchitis; airway clearance techniques (chest physiotherapy) are essential concurrent therapy. Egypt E-MOXCLAV 1G 10 F.C. TAB. EIPICO 14.00 EGP (1.40/unit) JULMENTIN 2X 1GM 15 TAB. JULPHAR 57.50 EGP (3.83/unit) DEXICLAVE 1 GM 10 F.C. TABS. RAMEDA > NOVE... 38.50 EGP (3.85/unit) MACLAVEX 1 GM 14 F.C.TABS. MASH PREMIERE 105.00 EGP (7.50/unit) CLAVIMOX 1 GM 12 F.C.TABS. PHARCO 130.00 EGP (10.83/unit) MEGAMOX 1 GM 14 F.C. TABS. AL JAZEERA PH... 178.00 EGP (12.71/unit) CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS. RAMEDA > ORGANOPHARMA 106.00 EGP AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETS GLAXO SMITHKLINE 169.00 EGP LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral solid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral solid IF PSEUDOMONAS ISOLATED 2. CIPROFLOXACIN [1st line] Adult 500-750 mg twice daily for 14 days when Pseudomonas aeruginosa is isolated or strongly suspected x 14 days Peds Specialist cystic fibrosis / pediatric pulmonology use only AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source BTS Guideline for Bronchiectasis in Adults 2019 Why Fluoroquinolone with activity against Pseudomonas aeruginosa, reserved for exacerbations where that organism is proven or strongly suspected, since it is not needed for the more typical bronchiectasis pathogens. Caution Reserve exclusively for proven or strongly suspected Pseudomonas aeruginosa exacerbations. CONTRAINDICATED in patients with history of fluoroquinolone-induced tendinitis or tendon rupture; discontinue immediately if tendon pain/inflammation occurs. Avoid co-administration with oral iron, calcium, dairy, or antacids (chelates and blocks absorption); check for QT prolongation. Egypt QUINOLOROX 500MG 10 F.C. TAB. EPCI > ROXXEN 10.00 EGP (1.00/unit) ECACIPROFLOX 500 MG 20 F.C. TABS. FUTURE PHARMACEUTICAL INDU... 27.00 EGP (1.35/unit) ELMODOXACIN 500MG 10 F.C.TAB. EGPI > SEA PHARM 20.00 EGP (2.00/unit) CIPROQUIN 500MG 10 F.C. TAB. UNIPHARMA 50.00 EGP (5.00/unit) CIPROFLOXACIN-ORGANO 500 MG 10 F.C.TABS. ORGANOPHARMA > ORGANO 63.00 EGP (6.30/unit) CIPROFAR 500MG 10 F.C.TAB. PHARCO 69.00 EGP (6.90/unit) CIPROMEGA XL 500MG 10 EXT. REL. F.C.TABS. MASH PREMIERE 48.00 EGP HEROXACIN 500MG 10 SCORED F.C. TAB. EGPI > HERO PHARM 69.00 EGP MAIN TREATMENT 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Bronchiectasis - disease-level clinical article (bronchiectasis-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Massive hemoptysis requires urgent bronchial artery embolization or surgery. 4. AZITHROMYCIN [add-on - not a substitute] Adult 250 mg once daily 3 days per week (e.g. Mon/Wed/Fri) as long-term anti-inflammatory prophylactic therapy in frequent exacerbators (>=3/year) - long-term (6-12 months) Peds Specialist pulmonology management only AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source BTS Guideline for Bronchiectasis in Adults 2019 Why Macrolide given long-term at reduced, intermittent dosing for its anti-inflammatory rather than antibacterial effect, aimed at cutting how often exacerbations occur in patients who flare frequently; added to, not instead of, standard treatment, and only after nontuberculous mycobacterial infection has been excluded. Caution Must exclude nontuberculous mycobacterial (NTM) infection prior to starting long-term macrolide maintenance. Perform baseline ECG (QT interval) and baseline audiometry. Egypt AZATRIBACT 250MG 6 CAPS. RIVA PHARMA S... 15.00 EGP (2.50/unit) AZOMYCIN 250MG 6 CAPS. PHARCO 25.20 EGP (4.20/unit) AZITHROMIN 250MG 6 CAPS. EL NILE. 31.50 EGP (5.25/unit) AZALIDE 250MG 6 CAPS. UP PHARMA 49.50 EGP (8.25/unit) NEOZOLID 250 MG 6 TABS. BORG 53.00 EGP (8.83/unit) AZI-ONCE 250MG 6 CAPS. JAMJOOM PHARM... 54.00 EGP (9.00/unit) ZITHROMAX 250MG 6 CAPS. PFIZER 79.00 EGP (13.17/unit) DISTABCIN 250 MG 6 DISPERSIBLE TABS. EGPI 43.50 EGP ZITHRODOSE 100MG/5ML SUSP. 15ML EL-OBOUR > AV... 12.00 EGP -> ? strength differs, ? different route - not oral solid ZITHROPHATE 200MG/5ML SUSP. 15ML ORGANO PHARMA... 12.75 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)