Table 3.

Graded antibiotic regimens

Antibiotic regimen	Dosing schedule	Additional options	Emergency plan	Example
Intermittent antibiotics	None		Attend GP with symptoms	n.a.
	None		Early use of home back‐up antibiotics	Co‐amoxyclav 625 mg tds for 2 weeks held at home
	Prophylactic antibiotics during the winter months with home rescue during the summer	Low‐dose and full‐dose options, e.g. Azithromycin 250–500 mg 3 days/week	Early use of home back‐up antibiotics	Azithromycin 3 days/week plus back‐up Co‐amoxyclav for 2 weeks held at home
Ongoing prophylaxis	Prophylactic antibiotics	Low‐dose and full‐dose options, e.g. Azithromycin 250–500 mg 3 days/week	Early use of home back‐up antibiotics	Azithromycin 3 days/week plus back‐up Co‐amoxyclav for 2 weeks held at home
	Rotating prophylactic antibiotics		Early use of home back‐up antibiotics
	Prophylactic antibiotics	Nebulized antibiotics	Early use of home back‐up antibiotics	Azithromycin 3 days/week plus back‐up Co‐amoxyclav for 2 weeks held at home
	Prophylactic antibiotics	Intermittent planned IVAB	Early use of home back‐up antibiotics	Azithromycin 3 days/week plus back‐up Co‐amoxyclav for 2 weeks held at home

Antibiotic prescribing should take into account the previous culture and sensitivity results as well as any allergies, tolerance and the likelihood of pseudomonas or macrolide‐resistant Haemophilus influenzae. If there has been no response to a back‐up course of antibiotics and a different second course of antibiotics, there should be a review and consideration for intravenous antibiotic (IVAB) treatment. Prophylactic and back‐up antibiotics should be different classes (e.g. macrolide and penicillin) and not an increase in dose of the existing prophylactic regimen. Monitoring and additional patient information may be needed, such as electrocardiogram (ECG) and hearing alterations for those on long‐term macrolides. There are many potential antibiotic options and the examples are illustrative, with individual decisions being made on clinical grounds. Nebulized antibiotics and intermittent IVAB are used mainly with severe bronchiectasis and pseudomonas colonization. GP = general practitioner; n.a. = not applicable; tds = three times a day.