No colonisation with P. aeruginosa:

Amoxicillin oral 1g 8 hourly

or

Doxycycline oral 200mg stat, then 100mg once daily

N.B. In pregnant patients, doxycycline is contraindicated. See here for an alternative option in penicillin allergic pregnant patients.

Colonised with P. aeruginosa:

• Base treatment on reported susceptibilities. See isolates reported as "I" (link only active if accessing via NHS network) for further information on dosing of ciprofloxacin. 
• If the isolate has been reported as resistant ("R" only) to ciprofloxacin, or the patient is unwell enough to warrant admission, discuss therapy with a respiratory physician or Infection Specialist.
• The only orally available antimicrobials with possible anti-pseudomonal activity are quinolones. The reported quinolone on P. aeruginosa isolates is ciprofloxacin.
• P. aeruginosa is never reported susceptible ("S") to ciprofloxacin, but can only be susceptible at increased dose ("I") [link only active if accessing via NHS network] or resistant ("R"). 
• P. aeruginosa reported as "R" to ciprofloxacin cannot be treated with oral antimicrobials. 

7 days if mild

10 days if moderate

14 days if severe

In patients with known bronchiectasis, acute exacerbations should be treated with antibiotics if the patient reports increased purulence of sputum AND increased sputum volume or viscosity AND one or several of:

• increased shortness of breath,
• worsening wheeze,
• increased cough, or
• systemic upset

Sputum samples should be sent for any patient with exacerbation of bronchiectasis.

In primary care, consider hospitalisation if features of a severe exacerbation are present, such as:

• marked dyspnoea, tachypnoea, hypoxia (<90% on room air), pursed-lip breathing, use of accessory muscles at rest,
• acute confusion,
• new-onset cyanosis,
• peripheral oedema, or
• marked reduction in performing usual activities of daily living