***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: 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 Mixed treatment comparison ( MTC ) meta- analysis is a generalization of st and ard pairwise meta- analysis for A vs B trials , to data structures that include , for example , A vs B , B vs C , and A vs C trials . There are two roles for MTC : one is to strengthen inference concerning the relative efficacy of two treatments , by including both ' direct ' and ' indirect ' comparisons . The other is to facilitate simultaneous inference regarding all treatments , in order for example to select the best treatment . In this paper , we present a range of Bayesian hierarchical models using the Markov chain Monte Carlo software WinBUGS . These are multivariate r and om effects models that allow for variation in true treatment effects across trials . We consider models where the between-trials variance is homogeneous across treatment comparisons as well as heterogeneous variance models . We also compare models with fixed ( unconstrained ) baseline study effects with models with r and om baselines drawn from a common distribution . These models are applied to an illustrative data set and posterior parameter distributions are compared . We discuss model critique and model selection , illustrating the role of Bayesian deviance analysis , and node-based model criticism . The assumptions underlying the MTC models and their parameterization are also discussed Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Patients with bronchiectasis suffer from sputum production , recurrent exacerbations , and progressive airway destruction .  Erythromycin is effective in diffuse panbronchiolitis , another suppurative airway disorder , although its efficacy is unknown in idiopathic bronchiectasis . A double-blind placebo-controlled study was therefore conducted to evaluate the effects of 8-week administration of low dose erythromycin ( 500 mg b.i.d . ) in steady-state idiopathic bronchiectasis . Patients in the erythromycin group ( n=11 , 8 female , mean age 50+/-15 yrs ) , but not the  placebo group ( n=10 , 8 female , mean age 59+/-16 yrs ) had significantly improved forced expiratory volume in one second , forced vital capacity and 24-h sputum volume after 8 weeks ( p<0.05 ) . There was no parallel improvement in sputum pathogens , leukocytes , interleukin (IL)-1alpha and IL-8 , tumour necrosis factor-alpha , or leukotriene B4 . The results of this pilot study show that low-dose erythromycin improves lung function and sputum volume in bronchiectasis . Further studies are indicated to evaluate the efficacy of long-term erythromycin therapy in bronchiectasis Introduction Bronchiectasis is a chronic pulmonary process characterized by recurrent respiratory infections leading to destruction of airways secondary to inflammation . We investigated whether the addition of 6-months ’ twice-weekly azithromycin to the existing treatment regimen in patients with pulmonary bronchiectasis decreased the number of exacerbations and improved pulmonary function compared with a similar period of time without concurrent azithromycin . Methods Thirty patients with high-resolution computed tomography scan-confirmed bronchiectasis were to be recruited . In r and om order , patients received usual medications for 6 months , and usual medications plus oral azithromycin 500 mg twice weekly for 6 months . Patients receiving azithromycin first had a 1-month washout period prior to entering the second phase . Patients recorded weekly peak flow ( PF ) measurements . Pulmonary function tests ( PFTs ) , 24-hour sputum volume , and needs for intervention with medication or ancillary support were collected at baseline and every 3 months . Exacerbation incidence and sputum volume measurements were compared from baseline to the end of each study phase . Results Twelve patients were enrolled ; 11 were included in the analysis . Owing to r and omization , most patients received the azithromycin first , which was fairly well tolerated . PFTs did not change significantly during either study phase and PFs appeared to remain stable during azithromycin therapy and throughout the subsequent control phase . Azithromycin significantly decreased the incidence of exacerbations compared with usual medications ( 5 vs 16 ; p = 0.019 ) . Mean 24-hour sputum volume significantly decreased ( 15 % [ p = 0.005 ] ) during the active treatment phase , and remained decreased during the control phase ( p = 0.028 ) . Subjectively , patients reported increased energy and quality of life while receiving treatment with azithromycin . Conclusions The addition of twice-weekly azithromycin significantly decreased the incidence of exacerbation and 24-hour sputum volume and may have stabilized the PFTs and PFs in this 11-patient pilot study . The results of this study justify further investigation of adding azithromycin to the treatment regimens of patients with bronchiectasis for its disease-modifying effects BACKGROUND AND OBJECTIVE To explore the effect of long-term therapy with azithromycin in regards to airway oxidative stress markers in exhaled breath condensate ( EBC ) of adult patients with stable non-cystic fibrosis ( CF ) bronchiectasis . METHODS Open-label prospect i ve study of 30 patients r and omized to azithromycin 250 mg three times per week during 3 months ( 16 patients ) or  control  ( 14 patients ) . Primary outcome were changes in nitric oxide , 8-isoprostane , pH , nitrites and nitrates in EBC . Secondary outcomes were changes in exacerbation rates , dyspnoea ( Borg scale ) , sputum volume ( cc ) , sputum colour ( 15-point scale ) , bacterial infection , health-related quality of life ( St George 's Respiratory Question naire ) , lung function and radiological extension . RESULTS Azithromycin produced a significant decrease in sputum volume ( 8.9 ( 1.8 ) mL vs 2.1 ( 3.4 ) mL ) and number of exacerbations ( 0.1 ( 0.6 ) vs 1.2 ( 0.9 ) ) . Dyspnoea ( 0.4 ( 0.1 ) vs 0.1 ( 0.2 ) ) and health-related quality of life also improved after therapy . However , oxidative stress markers in EBC , systemic inflammatory markers as well as functional respiratory tests did not differ from the control group after therapy . A post-hoc analysis comparing patients infected or not with Pseudomonas aeruginosa revealed that these effects were more pronounced in infected patients . In this subgroup , treatment was followed by a significant reduction in sputum volume , number of exacerbations , dyspnoea and St George 's Respiratory Question naire total score . Of all airway oxidative stress markers , only nitrates in EBC were reduced after therapy . CONCLUSIONS Long-term azythromicin treatment has some clinical benefits in patients with non-CF stable bronchiectasis , but it does not affect airway oxidative stress markers BACKGROUND Azithromycin is a macrolide antibiotic with anti-inflammatory and immunomodulatory properties . We tested the hypothesis that azithromycin would decrease the frequency of exacerbations , increase lung function , and improve health-related quality of life in patients with non-cystic fibrosis bronchiectasis . METHODS We undertook a r and omised , double-blind , placebo-controlled trial at three centres in New Zeal and . Between Feb 12 , 2008 , and Oct 15 , 2009 , we enrolled patients who were 18 years or older , had had at least one pulmonary exacerbation requiring antibiotic treatment in the past year , and had a diagnosis of bronchiectasis defined by high-resolution CT scan . We r and omly assigned patients to receive 500 mg azithromycin or placebo three times a week for 6 months in a 1:1 ratio , with a permuted block size of six and sequential assignment stratified by centre . Participants , research assistants , and investigators were masked to treatment allocation . The co primary endpoints were rate of event-based exacerbations in the 6-month treatment period , change in forced expiratory volume in 1 s ( FEV(1 ) ) before bronchodilation , and change in total score on St George 's respiratory question naire ( SGRQ ) . Analyses were by intention to treat . This study is registered with the Australian New Zeal and Clinical Trials Registry , number ACTRN12607000641493 . FINDINGS 71 patients were in the azithromycin group and 70 in the placebo group .  The rate of event-based exacerbations was 0·59 per patient in the azithromycin group and 1·57 per patient in the placebo group in the 6-month treatment period ( rate ratio 0·38 , 95 % CI 0·26 - 0·54 ; p<0·0001 ) . Prebronchodilator FEV(1 ) did not change from baseline in the azithromycin group and decreased by 0·04 L in the placebo group , but the difference was not significant ( 0·04 L , 95 % CI -0·03 to 0·12 ; p=0·251 ) . Additionally , change in SGRQ total score did not differ between the azithromycin ( -5·17 units ) and placebo groups ( -1·92 units ; difference -3·25 , 95 % CI -7·21 to 0·72 ; p=0·108 ) . INTERPRETATION Azithromycin is a new option for prevention of exacerbations in patients with non-cystic fibrosis bronchiectasis with a history of at least one exacerbation in the past year . FUNDING Health Research Council of New Zeal and and Auckl and District Health Board Charitable Trust IMPORTANCE Macrolide antibiotics such as erythromycin may improve clinical outcomes in non-cystic fibrosis ( CF ) bronchiectasis , although associated risks of macrolide resistance are poorly defined . OBJECTIVE To evaluate the clinical efficacy and antimicrobial resistance cost of low-dose erythromycin given for 12 months to patients with non-CF bronchiectasis with a history of frequent pulmonary exacerbations . DESIGN , SETTING , AND PARTICIPANTS Twelve-month , r and omized ( 1: 
    Output:
    
This meta- analysis suggested that long-term treatment with macrolides  significantly reduced the incidence of non-CF bronchiectasis exacerbation .
Moreover , azithromycin is more efficient than roxithromycin and erythromycin in preventing exacerbation