Although the use of inhaled antibiotics is the standard of care in cystic fibrosis, there is insufficient evidence to support use of inhaled antibiotics in patients with bronchiectasis not due to cystic fibrosis. Compared with systemic antibiotics, inhaled antibiotics could provide higher drug concentration locally at bronchus with well treatment effect. It is also a safe treatment way for bronchiectasis not due to cystic fibrosis with mild side effect of bronchospasm. Inhaled antibiotics can reduce airway bacterial load and achieved a significant reduction in exacerbation frequency. However, we cannot use inhaled antibiotics to make improvements in quality of life for these patients. According to 2019 British Thoracic Society Guideline for bronchiectasis in adults, we suggest offering long-term antibiotic treatment for adults with bronchiectasis who have three or more exacerbations per year. Especially for the patient with chronic Pseudomonas aeruginosa infection. Besides inhaled antibiotics, macrolides are also very effective treatment for bronchiectasis not due to cystic fibrosis. We can make different treatment choice based on different patient's condition.
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