Recognition that bronchiectasis in children is potentially reversible if diagnosed early and treated optimally, underpins many of the recommendations in the 2023 TSANZ position statement on chronic suppurative lung disease and bronchiectasis in children, adolescents and adults in Australia and New Zealand.
For example the statement, published in Respirology last year [link here] and summarised recently in The MJA [link here], strengthens recommendations for the management of newly detected Pseudomonas aeruginosa in respiratory secretions.
It now states that eradication therapy should be offered, rather than considered as was the recommendation in the earlier 2015 TSANZ guidelines.
The 2023 Statement also recommends antibiotics – oral, inhaled or IV depending on symptoms – be continued for at least 14 days, rather than the ten days stated in the 2015 guidelines.
The suggested pathway for treatment when P. aeruginosa is newly detected also includes repeat lower airway specimen for culture and sensitivity testing where possible
“The goal of long term antibiotics (> 2 months) is to reduce bacterial load and/or airway inflammation when eradication is not possible,” the MJA summary said.
The position statement recommended against long-term (>3-months) inhaled antibiotics (e.g., aminoglycosides, colistin) for patients with clinically stable bronchiectasis.