Meds for bronchi flare

I'd call back and request the antibiotics now (you could say that this is what is usually done by other doctors?) For my doctors the protocol is steroids plus antibiotic asap...given the theory that a lung flair up even if viral is likely to turn bacterial given the environment of bronchiectasis. Did you get antibiotics in this situation in the past? If so use that as your argument.

Thank you!!…I’ll call the docs office back.

Steroids are not usually prescribed with a bronchiectasis flare unless there is asthma involved and your chest is super wheezy. Hopefully, they ruled out pneumonia. If I sound poorly on stethoscope sometimes I'm sent for an Xray.

Thanks for that info!

When I had bronchiectasis flare up ( sinus infection , more sputum from lungs and more cough than normal) I was also given steroid - 5 days of prednisone, but no antibiotics. I also had an X-ray which did not show changes other than what I have. This all was given by an an call pulmonologist ( of course I got sick on the weekend) and confirmed by my pulmonologist. Well I thought I should be given an antibiotic. Yes I got better in about a week but I am still not sure it was enough. Next weeek I am going to NJH and planning to discuss it with dr so after that I will share on this forum.

My Doctor at Mayo will not perscribe an antibiotic without a sputum culture. The point is to target specific bacteria you have that is making you sick. Often the bacteria are antibiotic resistant so you have to be very specific about the antibiotic used.
This can be very frustrating!!!!! I am currently in a bad flare. I had to wait three days for the culture before my dr would prescribe and antibiotic. I totally understand the logic and reasoning but it is hard to be patient when you feel so bad.
The recurring bacteria I have is Pseudomonas Aeruginosa currently I am taking Levaquin. I usually feel better for a couple of weeks and then the cycle begins again.
My hope is to start a new treatment regimin of inhaled antibiotics . waiting for approval from the Great Insurance Gods 🙁

Are pulmonologists and infectious disease doctors even more concerned about antibiotic resistance for patients and with the long term consequences that can happen? A sputum test might identify a new bacteria that requires a specific antibiotic, but do people start antibiotics and then switch if needed after results?

It seems sinus involved infections might be viral in nature, at least in the early stages of infection, but no one wants the symptoms of a bacterial infection that might lead to other complications.

When I have an exacerbation I always submit a sputum culture before stating antibiotics. Weirdly, most times nothing grows in the lab yet an antibiotic helps. It's both a relief and a frustration that nothing grows from the culture. Doctor prescribes antibiotic because I have chills, malaise, headache, body aches, cough, increased sputum, etc. I will only take steroids when my chest is very wheezy. Headaches then are 8+/10. My latest thinking is that lack of sinus drainage is causing a sinus infection, which seeds the lung infection. Sinus surgery is in my future as I get way too many of these infections.

You asked, "Are pulmonologists and infectious disease doctors even more concerned about antibiotic resistance for patients and with the long term consequences that can happen?"
Yes, that is a huge concern especially because there are so few drugs in the arsenal for treating MAC. Also, not every flare is caused by bacteria - many are viral in nature, will run their course in 5-10 days, and antibiotics do nothing to cure them.

With both bronchiectasis and asthma, my "rescue plan" for flares, developed with my pulmonologist, is 2-3 days of increased nebs and airway clearance plus rest. If not getting better or getting worse, continue airway clearance and rest and start a course of steroids (I keep it on hand). After 3 days, if not improving, call her office and discuss next step. Only once in 2 years have we resorted to a course of antibiotics (I don't currently have "active" MAC, or the plan might be different.)

I highly recommend that everyone develop a "just in case" plan with their pulmonologist or ID doc - we all know how long it takes to gat an appointment these days! And the beauty of having a plan like this in place is that it doesn't matter if I am home or traveling - it can be implemented anywhere.

Sue

I am not making a recommendation here - only saying that, 25 years ago, it worked for me. The ENT counted 22 sinus/ear/throat infections in 2 years in my 40's and said "let's take a closer look." After scoping, he resorted to surgery and removed scar tissue, polyps, cleared out pockets of infection & straightened my septum (broken in a teenage water fight that involved metal buckets.) Once all was healed I could breathe normally through my nose for the first time in my life - I had my first recognized sinus infection at age 10.
Probably my bronchiectasis began to develop way back then from repeated bouts of bronchitis brought on by sinus infection drainage.
Sue