Around 300,000 people in the UK with bronchiectasis face a standard 14-day course of intravenous antibiotics when severely ill—but a pilot study suggests 7 days may work just as well, and this trial aims to prove it. The problem is that no randomised trial has ever tested the optimal duration. Current guidelines rely on expert opinion, leaving patients stuck in hospital longer than necessary and exposed to more side effects, while too-short treatment risks a rapid return of infection. A pilot study in Edinburgh with 90 patients found that those receiving 7 days of the antibiotic meropenem actually took longer to experience their next flare-up than those on 14 days, challenging the assumption that longer treatment is better. If this multi-centre trial of 400 patients confirms those results, it could change national and international guidelines, cutting hospital stays, reducing antibiotic side effects, and saving the NHS roughly £40 million per year in bronchiectasis admissions. For patients, it would mean less time in hospital and a longer gap before needing antibiotics again. The Asthma UK-British Lung Foundation alliance will help spread the findings to the public and clinicians.
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Bronchiectasis affects around 300,000 people in the UK, according to British Lung Foundation research. Data from England shows that hospital admissions due to bronchiectasis cost the NHS around £40M per year. International guidelines recommend that patients receive intravenous antibiotics for 14 days if they are particularly unwell, have an infection with resistant organisms, or if oral antibiotics are ineffective. The duration is based on expert advice but there have not been any randomised placebo controlled trials informing us what length of course is best. The dilemma being that treating for too long may keep people in hospital too long or increase their risk of antibiotic side effects, whereas treating for too short a period may increase the risk of an infection soon after completion of antibiotic therapy. We have shown both patients and clinicians would enter a trial of shorter courses of intravenous antibiotic treatment in a study in Edinburgh of 90 patients. We found patients receiving 7 days of intravenous antibiotic (meropenem) took longer to next flare up compared to those getting current recommendations of 14 days (meropenem). This challenges the current thinking that “more is better”. A multi-centre trial is now needed to confirm this and change the national and international guidelines 14 days treatment recommendation. We will select 400 patients with bronchiectasis throughout the UK who are needing to start intravenous antibiotics. Half, at random, will receive open labelled 7 days of intravenous antibiotic (meropenem) and the other half will get open labelled 14 days of intravenous antibiotic (meropenem). Both groups will get standard care in addition. In this study we have chosen to use a broad-spectrum antibiotic (Meropenem 2g intravenously three times daily) as it covers both gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa (the most frequent pathogen identified in those that need intravenous antibiotics), as well as anaerobes. In addition, it is the antibiotic of choice for participants with a penicillin allergy. The higher dosage is what is used as per national bronchiectasis guidelines. This antibiotic was used in our pilot randomised controlled study. The primary outcome is the time from starting intravenous antibiotic therapy to needing another antibiotic course for an exacerbation of bronchiectasis (up to 1 year post randomisation). We are using the internationally agreed definition of a bronchiectasis exacerbation. Our grant proposal has been reviewed by an expert patient panel who agreed this is an important study and that any treatment prolonging the time to next needing an antibiotic is welcome. They agreed the need for a multi-centre study, advised against bringing participants into hospital for the next flare-up after the intravenous antibiotic course, and agreed that an unblinded study was better value for money in view of the costs required to blind the study. The expert patient panel helped write the lay summary. The Asthma UK- British Lung Foundation alliance will provide strategic oversight of PPI work and will help with post study dissemination. We’ll present our findings at local, national, and international meetings. This study will help the NHS provide optimal care, and the findings will be applied internationally - so we will publish in a high impact factor peer reviewed journal. The Asthma UK- British Lung Foundation alliance have also agreed to help disseminate the results to the public
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