NICE 2018 Guidance for Mx of acute exacerbation of bronchiec
In a recently released guidance document, the NICE (National Institute for Health and Care Excellence) sets out an antimicrobial prescribing strategy for managing and preventing acute exacerbations of bronchiectasis (non-cystic fibrosis). It aims to optimise antibiotic use and reduce antibiotic resistance.

This guideline includes recommendations on:-
• treatment
• reassessment
• referral and seeking specialist advice
• choice of antibiotic for treatment
• prevention

The key recommendations are:-

A. Antibiotics - treatment
When choosing antibiotics, take account of:
• the severity of symptoms
• previous exacerbations, hospitalisations and risk of complications
• previous sputum culture and susceptibility results
• Give oral antibiotics first line if possible

B. Antibiotics – prophylaxis
• Only start a trial of antibiotic prophylaxis on specialist advice

• When considering antibiotic prophylaxis, discuss the possible benefits (reduced exacerbations), harms (increased antimicrobial resistance, adverse effects and interactions with other medicines) and the need for regular review

C. Reassessment
Reassess people with an acute exacerbation of bronchiectasis if their symptoms worsen rapidly or significantly at any time, taking account of:
• other possible diagnoses, such as pneumonia

• any symptoms or signs suggesting a more serious illness or condition, such as cardiorespiratory failure or sepsis

• previous antibiotic use, which may have led to resistant bacteria

D. Referral and seeking specialist advice
Seek specialist advice for people with an acute exacerbation of bronchiectasis if they:
• have symptoms that are not improving with repeated courses of antibiotic treatment or

• have bacteria that are resistant to oral antibiotics or

• cannot take oral medicines

About NICE
The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care. NICE’s role is to improve outcomes for people using the NHS and other public health and social care services.

Note: This list is a brief compilation of some of the key recommendations included in the guidelines and is not exhaustive and does not constitute medical advice. Kindly refer to the original publication here: https://www.nice.org.uk/guidance/ng117/chapter/Recommendations
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