guidelines

bronchiectasis (non-cystic fibrosis)

nice ng117 summary: diagnosis, baseline work-up, airway clearance, vaccination, exacerbation management, and first-line antibiotics (adult dosing table).

last reviewed: 2026-02-14
based on: NICE NG117 (published 20 Dec 2018; updated 22 Jul 2024) + NICE visual summary antibiotic table
reviewer: Dr Kola Tytler MBBS CertHE MBA MRCGP
view official NICE source

Executive summary

  • Think bronchiectasis in chronic productive cough, recurrent chest infections, or persistent sputum.
  • Confirm diagnosis: typically via specialist assessment and high-resolution CT.
  • Cornerstones: airway clearance techniques (physio), vaccination, sputum microbiology (especially if frequent exacerbations).
  • Exacerbations: take sputum sample where possible (especially if frequent or severe) and treat with appropriate antibiotics; use local resistance patterns and previous cultures.

Exacerbation antibiotics (adults) — NICE visual summary table

First choice (7 days):

  • Amoxicillin 500 mg three times daily

Alternatives (7 days):

  • Doxycycline 200 mg on day 1, then 100 mg once daily
  • Clarithromycin 500 mg twice daily

Severe symptoms / systemically very unwell (7 days):

  • Co-amoxiclav 500/125 mg three times daily
  • Levofloxacin 500 mg once or twice daily (specialist advice recommended)

If Pseudomonas aeruginosa suspected/known (specialist-linked):

  • Ciprofloxacin 500 mg or 750 mg twice daily for 14 days

Always check local guidance, renal function, interactions, allergy status, and current MHRA safety advice (notably for fluoroquinolones).

Prevention & baseline optimisation (high-yield checklist)

  • Airway clearance: refer for respiratory physiotherapy (teach daily clearance; escalate during exacerbations).
  • Vaccination: ensure influenza and pneumococcal vaccination per UK schedule/risk.
  • Sputum microbiology: culture-guided plans in recurrent disease; document colonisation (e.g., Pseudomonas).
  • Referral triggers: frequent exacerbations, haemoptysis, declining lung function, significant breathlessness, suspected underlying cause requiring work-up.

References (Harvard):

  • NICE (2024) Bronchiectasis (non-cystic fibrosis), NG117. https://www.nice.org.uk/guidance/ng117
  • NICE (2024) NG117 visual summary (PDF). https://www.nice.org.uk/guidance/ng117/resources/bronchiectasis-noncystic-fibrosis-visual-summary-pdf-8924641070

FAQs

Do I need a sputum culture on every exacerbation?
Not always, but it is strongly useful when there are frequent exacerbations, severe illness, prior resistant organisms, or known colonisation (e.g., Pseudomonas). Use local guidance.
Is 7 days always the correct duration?
NICE’s visual summary table uses 7 days for common first choices, but Pseudomonas regimens may be longer (e.g., 14 days) and specialist-led.
When should I refer to respiratory?
Frequent exacerbations, haemoptysis, suspected colonisation, diagnostic uncertainty, or functional decline.

Transparency

This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.