Exacerbation of chronic bronchiectasis

Case report:

52-year-old patient had bilateral bronchiectasis in the lower lobe for over 20 years and is continuously treated with antibiotics. The current acute symptoms is characterized by copious purulent expectoration of increase, increased shortness of breath and breathing temporarily dependent left-sided chest pain. On the two nights before visiting in practice temperatures had occurred up to 38.5 � C and there was a considerable malaise. The physical examination of quite thin, almost cachectic patient results in a respiratory rate of 20 / min and an indicated cyanosis. About the lung, in particular on the two lower lobe dorsal significant coarse bubble rales are auscultated with sonorous but to hypersonorem percussion. Pneumonic sounds are not audible.

Diagnosis and Etiology:

The patient suffers from, as already mentioned, for many years from a chronic Bronchiektasenkrankheit. You will meet resistance continuously treated with alternating antibiotics because antibiotics without constant infectious episodes with very high Sputummengen had occurred. The current infectious thrust was carried out under an ongoing therapy for six weeks with a daily intake of 100 mg of doxycycline (div. Trademark). It is carried out one day after discontinuation of the antibiotic a sputum; this provides a pure culture with Klebsiella pneumoniae (108 pathogen per mL).

Therapy:

In patients with antimicrobial long-term therapy a sputum analysis must periodically, but especially in infectious episodes, be made. On the basis of resistance testing is now made to be prescribed at a dose of 500 mg twice ciprofloxacin (Cipro). Other alternatives would be other fluoroquinolones like levofloxacin (Tavanic), moxifloxacin (Avelox). Also oral cephalosporin such as cefuroxime axetil (ELOBACT et al), cefixime (CEPHORAL) sowieLoracarbef (LORAFEM) could be used. It is necessary in this disease also an intense drainage therapy with plenty of liquid, secretolytics and respiratory therapeutic measures. The duration of treatment will be several weeks at this particular constellation, up for re-analysis of the sputum.