Chronic Pseudomonas in Bronchiectasis — RACP Adult Medicine MCQ

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HardInfectious DiseasesChronic Pseudomonas in BronchiectasisRACP Adult Medicine

A 60-year-old man with COPD presents with persistent Pseudomonas aeruginosa in sputum cultures despite multiple courses of oral ciprofloxacin. His FEV1 is 35% predicted. CT shows bilateral lower lobe bronchiectasis. What is the recommended long-term inhaled antibiotic for chronic Pseudomonas colonisation?

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Correct answer: A — Inhaled gentamicin

For COPD with bronchiectasis and chronic Pseudomonas aeruginosa colonisation (≥2 positive cultures over 12 months) despite acute exacerbation treatment, long-term inhaled antibiotics are recommended. In Australia, inhaled gentamicin or tobramycin are used (typically nebulised twice daily on an alternating month schedule). The ERS/BTS bronchiectasis guidelines support inhaled antibiotics for reducing exacerbation frequency. Microbiological sensitivity should guide choice. Regular monitoring for aminoglycoside ototoxicity and nephrotoxicity is needed.

Reference: eTG – 2025 – Antibiotic Guidelines; ERS – 2024 – Bronchiectasis Guidelines