Exacerbation of bronchiectasis and cystic fibrosis

Cystic fibrosis and alpha-1 protein deficiency are the most common causes for bronchiectasis. The importance of antibiotics in the treatment of exacerbations is generally accepted. Knowledge of the underlying pathogens and antibiotic resistance patterns are mandatory for a successful antibiotic treatment. Therefore, microbiological investigations of respiratory samples should be performed before the use of antibiotics in order to identify antibiotic resistance. Pseudomonas aeruginosa is a frequent pathogen in elderly patients with cystic fibrosis and,therefore, empirical treatment of exacerbations of cystic fibro-sis should always contain agents with anti-pseudomona I activity. In pulmonary exacerbations in patients with cystic fibrosis, high dose intravenous therapy with two antibiotics from different classes with anti-pseudomona I activity is necessary. In exacerbations of patients with bronchiectasis of other etiology than cystic fibrosis, empiric treatment with one orally administered antimicrobial agent is usually sufficient.