Less is more? Antibiotic treatment duration for exacerbations of bronchiectasis

Exacerbations of bronchiectasis are major drivers of morbidity and mortality [1–3]. Severe exacerbations requiring hospitalisation or intravenous antibiotics are particularly damaging, with a 4-year mortality rate of 25% and a major impact on healthcare resources, being the main contributor to healthcare costs in bronchiectasis [4–6]. Exacerbations are defined by an increase in respiratory symptoms requiring a change in treatment, which is usually an antibiotic [2]. In practice, the most common symptoms are cough, sputum production, sputum purulence, fatigue and breathlessness [2, 7]. In common with much of the bronchiectasis evidence base, we know far too little about what causes bronchiectasis exacerbations and almost nothing about how to treat them. Respiratory viruses, such as influenza and rhinovirus, have been identified in up to 50% of events [8, 9]. While bacteria are frequently isolated, the role of changes in bacterial load or strain at exacerbation is unclear, since bacteria are frequently identified in patients with bronchiectasis when clinically stable [10–12]. The first trial of antibiotic duration in bronchiectasis provides surprising results <https://bit.ly/2TeDmsX>