***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of this study was to investigate the long-term effectiveness and safety of inhaled antibiotic treatment in non-cystic fibrosis patients with bronchiectasis and chronic infection by Pseudomonas aeruginosa , after st and ard endovenous and oral therapy for long-term control of the infection had failed . After completing a 2-week endovenous antibiotic treatment to stabilize respiratory status , 17 patients were r and omly allocated to a 12-month treatment either with inhaled ceftazidime and tobramycin ( group A ) or a symptomatic treatment ( group B ) . One patient from group A ab and oned inhaled treatment because of bronchospasm and another from group B died before the end of the study . The remaining 15 patients , seven from group A and eight from group B , completed the study . Both groups had similar previous characteristics . The number of admissions and days of admission ( mean + /- SEM ) of group A [ 0.6 ( 1.5 ) and 13.1 ( 34.8 ) ] were lower than those of group B [ 2.5 ( 2.1 ) and 57.9 ( 41.8 ) ] ( P < 0.05 ) . Forced vital capacity ( FVC ) , forced expiratory volume in 1 sec ( FEV1 ) , PAO2 and PACO2 were similar in the two groups at the end of follow-up , showing a comparable decline in these parameters . There were no significant differences either in the use of oral antibiotics or in the frequency of emergence of antibiotic-resistant bacteria between groups . Microbiological studies suggested that several patients had different Pseudomonas aeruginosa strains . None of the patients presented impaired renal or auditory function at the end of the study . This study suggests that long-term inhaled antibiotic therapy may be safe and lessen disease severity in non-cystic fibrosis patients with bronchiectasis and chronic bronchial infection by Pseudomonas aeruginosa which do not respond satisfactorily to antibiotics administered via other routes RATIONALE Bronchiectasis is a chronic debilitating disease with few evidence -based long-term treatments . OBJECTIVES A r and omized controlled trial assessing the efficacy of nebulized gentamicin therapy over 1 year in patients with non-cystic fibrosis bronchiectasis . METHODS Sixty-five patients were r and omized to either twice-daily nebulized gentamicin , 80 mg , or nebulized 0.9 % saline , for 12 months . All were review ed at three-monthly intervals during treatment and at 3 months ' follow-up . MEASUREMENTS AND MAIN RESULTS At each review the following were assessed : quantitative and qualitative sputum bacteriology ; sputum purulence and 24-hour volume ; FEV(1 ) , FVC , and forced expiratory flow , midexpiratory phase ; exercise capacity ; Leicester Cough Question naire and St. George 's Respiratory Question naire ; and exacerbation frequency .  Fifty-seven patients completed the study . At the end of 12 months ' treatment , compared with the saline group , in the gentamicin group there was reduced sputum bacterial density with 30.8 % eradication in those infected with Pseudomonas aeruginosa and 92.8 % eradication in those infected with other pathogens ; less sputum purulence ( 8.7 % vs. 38.5 % ; P < 0.0001 ) ; greater exercise capacity ( 510 [ 350 - 690 ] m vs. 415 [ 267.5 - 530 ] m ; P = 0.03 ) ; and fewer exacerbations ( 0 [ 0 - 1 ] vs. 1.5 [ 1 - 2 ] ; P < 0.0001 ) with increased time to first exacerbation ( 120 [ 87 - 161.5 ] d vs. 61.5 [ 20.7 - 122.7 ] d ; P = 0.02 ) . The gentamicin group had greater improvements in Leicester Cough Question naire ( 81.4 % vs. 20 % ; P < 0.01 ) and St. George 's Respiratory Question naire ( 87.5 % vs. 19.2 % ; P < 0.004 ) score . No differences were seen in 24-hour sputum volume , FEV(1 ) , FVC , or forced expiratory flow , midexpiratory phase . No P. aeruginosa isolates developed resistance to gentamicin . At follow-up , all outcome measures were similar to baseline . CONCLUSIONS Regular , long-term nebulized gentamicin is of significant benefit in non-cystic fibrosis bronchiectasis but treatment needs to be continuous for its ongoing efficacy . Clinical trial registered with www . clinical trials.gov ( NCT 00749866 ) RATIONALE Chronic infection with Pseudomonas aeruginosa is associated with an increased exacerbation frequency , a more rapid decline in lung function , and increased mortality in patients with bronchiectasis . OBJECTIVES To perform a r and omized placebo-controlled study assessing the efficacy and safety of inhaled colistin in patients with bronchiectasis and chronic P. aeruginosa infection . METHODS Patients with bronchiectasis and chronic P. aeruginosa infection were enrolled within 21 days of completing a course of antipseudomonal antibiotics for an exacerbation . Participants were r and omized to receive colistin ( 1 million IU ; n = 73 ) or placebo ( 0.45 % saline ; n = 71 ) via the I-neb twice a day , for up to 6 months . MEASUREMENTS AND MAIN RESULTS The primary endpoint was time to exacerbation . Secondary endpoints included time to exacerbation based on adherence recorded by the I-neb , P. aeruginosa bacterial density , quality of life , and safety parameters . All analyses were on the intention-to-treat population . Median time ( 25 % quartile ) to exacerbation was 165 ( 42 ) versus 111 ( 52 ) days in the colistin and placebo groups , respectively ( P = 0.11 ) . In adherent patients ( adherence quartiles 2 - 4 ) , the median time to exacerbation was 168 ( 65 ) versus 103 ( 37 ) days in the colistin and placebo groups , respectively ( P = 0.038 ) . P. aeruginosa density was reduced after 4 ( P = 0.001 ) and 12 weeks ( P = 0.008 ) and the St. George 's Respiratory Question naire total score was improved after 26 weeks ( P = 0.006 ) in the colistin versus placebo patients , respectively . There were no safety concerns . CONCLUSIONS Although the primary endpoint was not reached , this study shows that inhaled colistin is a safe and effective treatment in adherent patients with bronchiectasis and chronic P. aeruginosa infection . Clinical trial registered with http://www.is rct n.org/ ( IS RCT N49790596 ) Rationale : Previous studies have demonstrated that long-term low-dose macrolides are efficacious in cystic fibrosis ( CF ) and diffuse panbronchiolitis , two chronic neutrophilic airway diseases . Aims : The aims of this study were to evaluate the efficacy and safety of low-dose neomacrolides as add-on therapy in patients with severe asthma and /or bronchiectasis and to identify predictors for therapeutic response . Methods : In a retrospective observational cohort study , we examined 131 adult , non-CF patients with severe asthma and /or bronchiectasis , receiving low-dose neomacrolides as add-on treatment .  Pulmonary function tests and symptom scores were assessed at baseline and after 3 to 8 weeks of therapy . Results : After 3–8 weeks of treatment with low-dose neomacrolides , 108 patients were available for evaluation . In asthma patients ( n = 47 ) , pulmonary function tests and symptom scores improved significantly . Responders ( ≥7 % forced expiratory volume in one second predicted [ FEV1 % ] improvement ) were older ( 55 vs. 47 years ; p = 0.042 ) and had a longer duration of asthma ( 29 vs. 9 years ; p = 0.052 ) . In patients with bronchiectasis only ( n = 61 ) , symptom scores improved significantly . Responders ( ≥60 % symptom score improvement ) were older ( 61 vs. 53 years ; p = 0.004 ) , more frequently male ( 53 % vs. 27 % ; p = 0.043 ) , and there was a nonsignificant trend towards higher high-resolution CT ( H RCT ) score for bronchiectasis in responders ( 6.4 vs. 4.6 ; p = 0.053 ) . In multivariate logistic regression analysis , age and male gender were independent predictors for improvement in this group . Conclusion : The results of this retrospective study suggest that neomacrolides may be useful as an add-on therapy in patients with severe asthma and /or bronchiectasis . Older age may predict good response in patients with severe asthma , whereas older age , male gender and a higher H RCT score for bronchiectasis may predict therapeutic response in patients with bronchiectasis only . Prospect i ve controlled trials of neomacrolides in patients with severe asthma are needed to confirm these observations IMPORTANCE Macrolide antibiotics have been shown beneficial in cystic fibrosis ( CF ) and diffuse panbronchiolitis , and earlier findings also suggest a benefit in non-CF bronchiectasis . OBJECTIVE To determine the efficacy of macrolide maintenance treatment for adults with non-CF bronchiectasis . DESIGN , SETTING , AND PARTICIPANTS The BAT ( Bronchiectasis and Long-term Azithromycin Treatment ) study , a r and omized , double-blind , placebo-controlled trial conducted between April 2008 and September 2010 in 14 hospitals in The Netherl and s among 83 out patients with non-CF bronchiectasis and 3 or more lower respiratory tract infections in the preceding year . INTERVENTIONS Azithromycin ( 250 mg daily ) or placebo for 12 months . MAIN OUTCOME MEASURES Number of infectious exacerbations during 12 months of treatment . Secondary end points included lung function , sputum bacteriology , inflammatory markers , adverse effects , symptom scores , and quality of life . RESULTS Forty-three participants ( 52 % ) received azithromycin and 40 ( 48 % ) received  placebo and were included in the modified intention-to-treat analysis . At end of study , the median number of exacerbations in the azithromycin group was 0 ( interquartile range [ IQR ] , 0 - 1 ) , compared with 2 ( IQR , 1 - 3 ) in the placebo group ( P < .001 ) . Thirty-two ( 80 % ) placebo-treated vs 20 ( 46 % ) azithromycin-treated individuals had at least 1 exacerbation ( hazard ratio , 0.29 [ 95 % CI , 0.16 - 0.51 ] ) . In a mixed-model analysis , change in forced expiratory volume in the first second of expiration ( percent of predicted ) over time differed between groups ( F1,78.8 = 4.085 , P = .047 ) , with an increase of 1.03 % per 3 months in the azithromycin group and a decrease of 0.10 % per 3 months in the placebo group . Gastrointestinal adverse effects occurred in 40 % of patients in the azithromycin group and in 5 % in the placebo group ( relative risk , 7.44 [ 95 % CI , 0.97 - 56.88 ] for abdominal pain and 8.36 [ 95 % CI , 1.10 - 63.15 ] for diarrhea ) but without need for discontinuation of study treatment . A macrolide resistance rate of 88 % was noted in azithromycin-treated individuals , compared with 26 % in the placebo group . CONCLUSIONS AND RELEVANCE Among adults with non-CF bronchiectasis , the daily use of azithromycin for 12 months compared with placebo result ed in a lower rate of infectious exacerbations . This could result in better quality of life and might influence survival , although effects on antibiotic resistance need to be considered . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00415350 Background The delivery of antipseudomonal antibiotics by inhalation to Pseudomonas aeruginosa-infected subjects with non-cystic fibrosis ( CF ) bronchiectasis is a logical extension of treatment strategies successfully developed in CF bronchiectasis .  Dual release ciprofloxacin for inhalation ( DRCFI ) contains liposomal ciprofloxacin , formulated to optimise airway antibiotic delivery . Methods Phase II , 24-week Australian/New Zeal and multicentre , r and omised , double-blind , placebo-controlled trial in 42 adult bronchiectasis subjects with ≥2 pulmonary exacerbations in the prior 12 months and ciprofloxacin-sensitive P aeruginosa at screening . Subjects received DRCFI 
    Output:
    
Studies of inhaled tobramycin have revealed conflicting results regarding quality of life ( QoL ) , exacerbations and admissions , but may result in sputum cultures negative for Pseudomonas aeruginosa , whereas studies investigating the effect of inhaled gentamycin have shown positive effects on sputum bacterial density , decrease in sputum cultures positive for P. aeruginosa , QoL and exacerbation rate , but no improvement in forced expiratory volume in first second ( FEV1 ) .
Oral azithromycin can reduce exacerbations , together with minor improvements in QoL and FEV1 .
Furthermore , oral erythromycin reduces exacerbations , but has no effect on lung function , symptoms or QoL. Inhaled ciprofloxacin may reduce P. aeruginosa in sputum cultures , but without changes in lung function , exacerbations or QoL. Although with limited evidence , inhaled colistin may have effects on P. aeruginosa density , exacerbations and QoL , whereas studies on aztreonam revealed no significant clinical improvements in the outcomes of interest , including exacerbation rate .
Adverse events , including bronchospasm , have been reported in association with tobramycin and aztreonam .
Several antibiotic treatment regimens have been shown to improve QoL and exacerbation rate , whereas findings regarding sputum production , lung function and admissions have been conflicting .