Dawaa Reference

chronic

Bronchiectasis (Non-CF Exacerbation & Suppression)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources1 source

BTS Guideline for Bronchiectasis in Adults 2019

Verified against3 documents
  • BTS Guideline for Bronchiectasis in Adults 2019
  • Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph)
  • Bronchiectasis - disease-level clinical article (bronchiectasis-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • A long history of a chronic, productive cough with purulent sputum is typical [cough · sputum]
  • Recurrent chest infections needing antibiotics over several years are commonly reported
  • Progressive breathlessness, intermittent wheeze, coughing up blood, and pleuritic pain can occur, with fatigue and weight loss [breathlessness · chest pain · coughing up blood · fatigue · weight loss · wheeze]
  • Blood-streaked purulent sputum is usually mild, though it can rarely become life-threatening [sputum]
  • Cough is reported in about 98% of patients and sputum production in about 78% [cough · sputum]
  • A flare-up shows increased sputum, breathlessness, cough, wheeze, and fever, with reduced lung function [breathlessness · cough · fever · sputum · wheeze]

Signs — what you find (5)

  • General exam findings are nonspecific
  • Digital clubbing occurs in only about 2% to 3% of patients, alongside cyanosis, plethora, and wasting [cyanosis · finger clubbing · muscle wasting]
  • Chest auscultation most often reveals crackles and wheezes [crackles]
  • Crackles, usually heard at both lung bases, are found in about 75% of patients [crackles]
  • Wheezing is heard in about 22%, from airflow obstruction by secretions [wheeze]

Tests (9)

  • Immunoglobulin testing (IgA, IgM, IgG, IgE) is checked to look for an underlying cause
  • ABPA is excluded with Aspergillus-specific IgE, Aspergillus IgG, and an eosinophil count
  • Cystic fibrosis testing (sweat test or common mutation screening) is done under age 40, or with recurrent Pseudomonas or Staph infection, or upper-lobe disease at any age
  • Chest x-ray is usually the first imaging test ordered
  • X-ray can show parallel line shadows, tram-track opacities, or ring shadows from thickened, dilated bronchial walls
  • CT is more sensitive and specific than chest x-ray and can narrow the differential to a few causes
  • The hallmark CT sign is bronchial dilation, defined by a broncho-arterial ratio over 1
  • On CT, airways visible within 1 cm of the pleural surface indicate bronchiectasis
  • Spirometry shows a fall in FEV1 from airflow obstruction and a rise in residual volume from air trapping

If not this — what else fits (4)

  • Alpha-1 antitrypsin deficiency and aspiration pneumonitis or pneumonia are considered
  • Asthma, bronchitis, and COPD are also on the differential
  • Cystic fibrosis and emphysema are further considerations
  • GERD and tuberculosis round out the differential list

SourceStatPearls "Bronchiectasis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Exacerbation - first line | If Pseudomonas isolated | Main treatment

EXACERBATION - FIRST LINE

1

AMOXICILLIN + CLAVULANIC ACID

Exacerbation - first line

1st line

Strength1000 mg

Formoral.solid

Adult dose and duration

875/125 mg twice daily or 500/125 mg three times daily for 10-14 days during acute exacerbation x 10-14 days

Paediatric dose

40-45 mg/kg/day [child max 1750 mg]

(Of amoxicillin component divided BID for 10-14 days under pediatric pulmonology supervision. Ceiling of 1750 mg/day is the Egyptian National Drug Formulary maximum for the 7:1 formulation; the BTS guideline is an adults document and sets no pediatric limit.)

Dose by weight
3kg120-135 mg/day
4kg160-180 mg/day
5kg200-225 mg/day
6kg240-270 mg/day
7kg280-315 mg/day
8kg320-360 mg/day
9kg360-405 mg/day
10kg400-450 mg/day
11kg440-495 mg/day
12kg480-540 mg/day
13kg520-585 mg/day
14kg560-630 mg/day
15kg600-675 mg/day
16kg640-720 mg/day
17kg680-765 mg/day
18kg720-810 mg/day
19kg760-855 mg/day
20kg800-900 mg/day
21kg840-945 mg/day
22kg880-990 mg/day
23kg920-1035 mg/day
24kg960-1080 mg/day
25kg1000-1125 mg/day
26kg1040-1170 mg/day
27kg1080-1215 mg/day
28kg1120-1260 mg/day
29kg1160-1305 mg/day
30kg1200-1350 mg/day
31kg1240-1395 mg/day
32kg1280-1440 mg/day
33kg1320-1485 mg/day
34kg1360-1530 mg/day
35kg1400-1575 mg/day
36kg1440-1620 mg/day
37kg1480-1665 mg/day
38kg1520-1710 mg/day
39kg1560-1750 mg/day (upper capped)
40kg1600-1750 mg/day (upper capped)
41kg1640-1750 mg/day (upper capped)
42kg1680-1750 mg/day (upper capped)
43kg1720-1750 mg/day (upper capped)
44kg1750 mg/day (capped)
45kg1750 mg/day (capped)
46kg1750 mg/day (capped)
47kg1750 mg/day (capped)
48kg1750 mg/day (capped)
49kg1750 mg/day (capped)
50kg1750 mg/day (capped)
Dose source

BTS Guideline for Bronchiectasis in Adults 2019

Why

Broad-spectrum penicillin and beta-lactamase inhibitor combination used to treat an acute bronchiectasis exacerbation, targeting the typical respiratory pathogens found in these damaged airways; paired with chest physiotherapy rather than used alone.

Cautions
  • CONTRAINDICATED in penicillin/beta-lactam hypersensitivity and in history of co-amoxiclav-associated jaundice or hepatic dysfunction.
  • Obtain sputum culture and sensitivity prior to starting antibiotics whenever possible (review against prior microbiology).
  • Longer duration (10-14 days) is required compared to uncomplicated bronchitis; airway clearance techniques (chest physiotherapy) are essential concurrent therapy.
Egyptian brands
Egyptian brandManufacturerIndicative price
E-MOXCLAV 1G 10 F.C. TAB.EIPICO14.00 EGP (1.40/unit)
JULMENTIN 2X 1GM 15 TAB.JULPHAR57.50 EGP (3.83/unit)
DEXICLAVE 1 GM 10 F.C. TABS.RAMEDA > NOVELL PHARMA38.50 EGP (3.85/unit)
MACLAVEX 1 GM 14 F.C.TABS.MASH PREMIERE105.00 EGP (7.50/unit)
CLAVIMOX 1 GM 12 F.C.TABS.PHARCO130.00 EGP (10.83/unit)
MEGAMOX 1 GM 14 F.C. TABS.AL JAZEERA PHARMACEUTICAL > HIKMA PHARMA178.00 EGP (12.71/unit)
CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS.RAMEDA > ORGANOPHARMA106.00 EGP
AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETSGLAXO SMITHKLINE169.00 EGP
LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML? strength differs? different route - not oral solidMISR > AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.8.00 EGP
MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML? strength differs? different route - not oral solidCID8.00 EGP

IF PSEUDOMONAS ISOLATED

2

CIPROFLOXACIN

If Pseudomonas isolated

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

500-750 mg twice daily for 14 days when Pseudomonas aeruginosa is isolated or strongly suspected x 14 days

Paediatric dose

Specialist cystic fibrosis / pediatric pulmonology use only

AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

BTS Guideline for Bronchiectasis in Adults 2019

Why

Fluoroquinolone with activity against Pseudomonas aeruginosa, reserved for exacerbations where that organism is proven or strongly suspected, since it is not needed for the more typical bronchiectasis pathogens.

Cautions
  • Reserve exclusively for proven or strongly suspected Pseudomonas aeruginosa exacerbations.
  • CONTRAINDICATED in patients with history of fluoroquinolone-induced tendinitis or tendon rupture; discontinue immediately if tendon pain/inflammation occurs.
  • Avoid co-administration with oral iron, calcium, dairy, or antacids (chelates and blocks absorption); check for QT prolongation.
Egyptian brands
Egyptian brandManufacturerIndicative price
QUINOLOROX 500MG 10 F.C. TAB.EPCI > ROXXEN10.00 EGP (1.00/unit)
ECACIPROFLOX 500 MG 20 F.C. TABS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > EGYPTIAN CANADIAN PHARMACEUTICAL27.00 EGP (1.35/unit)
ELMODOXACIN 500MG 10 F.C.TAB.EGPI > SEA PHARM20.00 EGP (2.00/unit)
CIPROQUIN 500MG 10 F.C. TAB.UNIPHARMA50.00 EGP (5.00/unit)
CIPROFLOXACIN-ORGANO 500 MG 10 F.C.TABS.ORGANOPHARMA > ORGANO63.00 EGP (6.30/unit)
CIPROFAR 500MG 10 F.C.TAB.PHARCO69.00 EGP (6.90/unit)
CIPROMEGA XL 500MG 10 EXT. REL. F.C.TABS.MASH PREMIERE48.00 EGP
HEROXACIN 500MG 10 SCORED F.C. TAB.EGPI > HERO PHARM69.00 EGP

MAIN TREATMENT

3

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Bronchiectasis - disease-level clinical article (bronchiectasis-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Massive hemoptysis requires urgent bronchial artery embolization or surgery.
4

AZITHROMYCIN

add-on - not a substitute

Strength250 mg

Formoral.solid

Adult dose and duration

250 mg once daily 3 days per week (e.g. Mon/Wed/Fri) as long-term anti-inflammatory prophylactic therapy in frequent exacerbators (>=3/year) - long-term (6-12 months)

Paediatric dose

Specialist pulmonology management only

AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

BTS Guideline for Bronchiectasis in Adults 2019

Why

Macrolide given long-term at reduced, intermittent dosing for its anti-inflammatory rather than antibacterial effect, aimed at cutting how often exacerbations occur in patients who flare frequently; added to, not instead of, standard treatment, and only after nontuberculous mycobacterial infection has been excluded.

Cautions
  • Must exclude nontuberculous mycobacterial (NTM) infection prior to starting long-term macrolide maintenance.
  • Perform baseline ECG (QT interval) and baseline audiometry.
Egyptian brands
Egyptian brandManufacturerIndicative price
AZATRIBACT 250MG 6 CAPS.RIVA PHARMA S.A.E.15.00 EGP (2.50/unit)
AZOMYCIN 250MG 6 CAPS.PHARCO25.20 EGP (4.20/unit)
AZITHROMIN 250MG 6 CAPS.EL NILE.31.50 EGP (5.25/unit)
AZALIDE 250MG 6 CAPS.UP PHARMA49.50 EGP (8.25/unit)
NEOZOLID 250 MG 6 TABS.BORG53.00 EGP (8.83/unit)
AZI-ONCE 250MG 6 CAPS.JAMJOOM PHARMACEUTICALS54.00 EGP (9.00/unit)
ZITHROMAX 250MG 6 CAPS.PFIZER79.00 EGP (13.17/unit)
DISTABCIN 250 MG 6 DISPERSIBLE TABS.EGPI43.50 EGP
ZITHRODOSE 100MG/5ML SUSP. 15ML? strength differs? different route - not oral solidEL-OBOUR > AVERROES PHARMA-EGYPT12.00 EGP
ZITHROPHATE 200MG/5ML SUSP. 15ML? strength differs? different route - not oral solidORGANO PHARMA > NOVELL PHARMA12.75 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.