Treatment of Bronchiectasis at High Risk of Exacerbations with Chronic Pseudomonas aeruginosa Infection

This protocol addresses patients with bronchiectasis who meet criteria for high exacerbation risk and who also have chronic airway infection with Pseudomonas aeruginosa — a combination that calls for a specific, stepwise management approach.

Clinical Scenario

High risk of exacerbations is defined by any of the following:

  • History of two or more exacerbations in the prior year
  • At least one severe exacerbation
  • One exacerbation alongside severe daily symptoms

In addition, the patient has chronic airway infection with Pseudomonas aeruginosa, persisting despite standard care.

Treatment Approach

Partial overview — full regimen below

After optimising underlying bronchiectasis management, the protocol specifies long-term antibiotic therapy, with the choice of approach guided by individual patient factors and preferences.

The complete algorithm — including sequencing, selection criteria, and what to exclude before starting — is available in the structured protocol.

Treatment goal: Reduction in exacerbation frequency, assessed over a 12-month period.
Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1183/13993003.01126-2025

  • We recommend to offer long-term inhaled antibiotics to patients at high risk of exacerbations and chronic infection with P. aeruginosa despite standard care.
  • Patients at high risk of exacerbations include patients with a history of ⩾2 exacerbations in the prior year OR ⩾1 severe exacerbation OR 1 exacerbation plus severe daily symptoms.
  • Patients with P. aeruginosa may receive either a long-term macrolide or long-term inhaled antibiotic as first-line treatment, with the choice based on patient preference and an individualised assessment of risks.
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