Summary of antibiotic treatments recommended in CRDs

Type of CRD
IndicationCystic fibrosisCOPDSevere asthmaBronchiectasis
Bacterial prophylaxisStaphylococcus aureus
 UK: flucloxacillin the first 3 years of life [15, 16]
 Other countries: not recommended   (uncertainty on clinical consequences   and on P. aeruginosa colonisation [17])
Bacterial eradicationPseudomonas aeruginosa
 First-line treatment: 28 days of TIS or up   to 3 months of a combination of   nebulised colistin and oral   ciprofloxacin [16]
 Aggressive therapy: i.v. meropenem or   i.v. tobramycin [15]
 Combined oral and i.v. antibiotic   regimen (fusidic acid, rifampicin,   teicoplanin and vancomycin) [15]
NANAP. aeruginosa
 First-line treatment: 14 days of oral ciprofloxacin
 If persistence of positive culture of sputum samples: i.v. treatment (e.g. β-lactam+aminoglycoside) or inhaled antibiotics (e.g. colistin, tobramycin or gentamicin) with a total duration of 3 months [18, 19]
Chronic suppressive therapyP. aeruginosa
 Intermittent therapy: treatment with TIS   for 28 days (300 mg twice daily) on   alternate months (28-day on/off)
 Alternatives: TIP, inhaled aztreonam   lysine, colistimethate dry powder or   LIS [16, 2022]
 Continuous daily administration mode   also increasingly recommended [23]
Maintenance therapy
 Proposition of 6 months of oral   azithromycin with a 3 times a week   dose of 500 mg [27]
Key pathogens
 Antibiotic courses administered 3 times per week [24]
Maintenance therapies
 Infra-dose of azithromycin [25]
Maintenance therapy
 Oral infra-dose of azithromycin for 48 weeks
 Azithromycin 3 times per week orally, in addition to inhaled corticosteroids and long-acting bronchodilators [7]
Recurrent (≥3 per year) or severe acute PEx [19, 26]
 Long-term inhaled antibiotics (nebulised gentamicin, TIS, colistimethate dry powder, dry powder or liposomal ciprofloxacin), usually prescribed on alternate months [18]
 Long-term oral treatment with macrolide or other molecules [18, 26]
Treatment of PExP. aeruginosa-induced PEx
 4 days with i.v. administration route [16];   oral or inhaled administration route   can also be used [15, 23]
Other bacterial species-related PEx
 ≥2 antibiotics with different mechanisms   of actions [16]
Antibiotic therapy: not systemically recommended [25, 28]
Duration of antibiotic treatment: 5–10 days [28]
Antibiotic therapy: not systemically recommended except in cases of documented pneumopathy [29]Antibiotic therapy: 14 days of antibiotics are recommended
First-line: oral antibiotics
In case of severity: i.v. ± inhaled colistimethate dry powder [18, 19, 26]

CRD: chronic respiratory disease; COPD: chronic obstructive pulmonary disease; PEx: pulmonary exacerbations; NA: not applicable; TIS: tobramycin solution for inhalation; i.v.: intravenous; MRSA: methicillin-resistant Staphylococcus aureus; TIP: tobramycin inhaled powder; LIS: levofloxacin inhaled solution.