***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: A study was conducted to determine whether a direct relationship exists between β-lactam and /or aminoglycoside activity measured in vitro and bacteriological outcome in acute pulmonary exacerbations of cystic fibrosis . Twenty-seven patients , aged between 6 months and 24 years ( mean age 10 1/2 years ) , were included in the study and received 41 i.v . courses of a β-lactam agent combined with an aminoglycoside . A total of 63Pseudomonas aeruginosa strains were found in sputum taken on admission at densities exceeding 106 cfu/g of sputum . For each episode , the serum inhibitory quotient ( SIQ ) and the serum bactericidal quotient ( SBQ ) of the β-lactam agent and of the aminoglycoside administered were determined for thePseudomonas aeruginosa isolate(s ) . The SIQs and SBQs were calculated by dividing the average peak serum levels achievable in the patients by the minimal inhibitory concentrations and minimal bactericidal concentrations , respectively . The SIQs and SBQs were compared to bacteriological outcome . Bacteriological success was defined as a decrease of 2 log10 counts or more in thePseudomonas aeruginosa density in sputum between days 0 and 7 of therapy . The SIQ and SBQ of β-lactam agents were good predictors of bacteriological outcome : SIQs of < 1:16 were 100 % predictive of failure ( χ2 28 ; p<0.001 ) and of ≥ 1:64 were 92.9 % predictive of success ( χ2 35.68 ; p<0.001 ) ; SBQs of < 1:8 were 100 % predictive of failure ( χ2 42.78 ; p<0.001 ) and of ≥ 1:32 were 95.8 % predictive of success ( χ2 31.5 ; p<0.001 ) . Aminoglycoside SIQs and SBQs were not predictive of outcome BACKGROUND Previous aztreonam for inhalation solution ( AZLI ) studies included patients with cystic fibrosis , Pseudomonas aeruginosa ( PA ) airway infection , and forced expiratory volume in 1s ( FEV(1 ) ) 25 % to 75 % predicted . This double-blind , multicenter , r and omized , placebo-controlled trial enrolled patients ( ≥6 years ) with FEV(1)>75 % predicted . METHODS AZLI 75 mg ( n=76 ) or placebo ( n=81 ) was administered 3-times daily for 28days with a 14-day follow-up . RESULTS Day 28 treatment effects were 1.8points for CFQ-R-Respiratory Symptoms Scale ( 95%CI : -2.8 , 6.4 ; p=0.443 ; primary endpoint ) ; -1.2 for log(10 ) sputum PA colony-forming units ( p=0.016 ; favoring AZLI ) , and 2.7 % for relative FEV(1)% predicted ( p=0.021 ; favoring AZLI ) . Treatment effects favoring AZLI were larger for patients with baseline FEV(1 ) < 90 % predicted compared to ≥90 % predicted . AZLI was well-tolerated . CONCLUSIONS Effects on respiratory symptoms were modest ; however , FEV(1 ) improvements and bacterial density reductions support a possible role for AZLI in these relatively healthy patients CONTEXT Treatment strategies for cystic fibrosis ( CF ) lung disease include antibiotics , mucolytics , and anti-inflammatory therapies . Increasing evidence suggests that macrolide antibiotics might be beneficial in patients with CF . OBJECTIVE To determine if an association between azithromycin use and pulmonary function exists in patients with CF . DESIGN AND SETTING A multicenter , r and omized , double-blind , placebo-controlled trial conducted from December 15 , 2000 , to May 2 , 2002 , at 23 CF care centers in the United States . PARTICIPANTS Of the 251 screened participants with a diagnosis of CF , 185 ( 74 % ) were r and omized . Eligibility criteria included age 6 years or older , infection with Pseudomonas aeruginosa for 1 or more years , and a forced expiratory volume in 1 second ( FEV1 ) of 30 % or more . Participants were stratified by FEV1 ( > or = 60 % predicted vs < 60 % predicted ) , weight of less than 40 kg vs 40 kg or more , and CF center . INTERVENTION The active group ( n = 87 ) received 250 mg ( weight < 40 kg ) or 500 mg ( weight > or = 40 kg ) of oral azithromycin 3 days a week for 168 days ; placebo group ( n = 98 ) received identically packaged tablets . MAIN OUTCOME MEASURES Change in FEV1 from day 0 to completion of therapy at day 168 and determination of safety . Secondary outcomes included pulmonary exacerbations and weight gain . RESULTS The azithromycin group had a mean 0.097-L ( SD , 0.26 ) increase in FEV1 at day 168 compared with 0.003 L ( SD , 0.23 ) in the placebo group ( mean difference , 0.094 L ; 95 % confidence interval [ CI ] , 0.023 - 0.165 ; P = .009 ) . Nausea occurred in 17 % more participants in the azithromycin group ( P = .01 ) , diarrhea in 15 % more ( P = .009 ) , and wheezing in 13 % more ( P = .007 ) . Participants in the azithromycin group had less risk of experiencing an exacerbation than participants in the placebo group ( hazard ratio , 0.65 ; 95 % CI , 0.44 - 0.95 ; P = .03 ) and weighed at the end of the study an average 0.7 kg more than participants receiving placebo ( 95 % CI , 0.1 - 1.4 kg ; P = .02 ) . CONCLUSION Azithromycin treatment was associated with improvement in clinical ly relevant end points and should be considered for patients with CF who are 6 years or older and chronically infected with P aeruginosa Chronic airway infection with Pseudomonas aeruginosa ( PA ) causes morbidity and mortality in patients with cystic fibrosis ( CF ) . Additional anti-PA therapies are needed to improve health status and health-related quality of life . AIR-CF3 was an international 18-month , open-label study to evaluate the safety and efficacy of repeated courses of aztreonam for inhalation solution ( AZLI , now marketed as Cayston ® ) in patients aged ≥ 6 years with CF and PA infection who previously participated in one of two Phase 3 studies : AIR-CF1 or AIR-CF2 . Patients received up to nine courses ( 28 days on/28 days off ) of 75 mg AZLI two ( BID ) or three times daily ( TID ) based on r and omization in the previous trials . 274 patients , mean age 28.5 years ( range : 8 - 74 years ) , participated . Mean treatment adherence was high ( 92.0 % BID group , 88.0 % TID group ) . Hospitalization rates were low and adverse events were consistent with CF . With each course of AZLI , FEV(1 ) and scores on the Cystic Fibrosis Question naire-Revised Respiratory Symptom scale improved and bacterial density in sputum was reduced . Benefits waned in the 28 days off therapy , but weight gain was sustained over the 18 months . There were no sustained decreases in PA susceptibility . A dose response was observed ; AZLI TID-treated patients demonstrated greater improvements in lung function and respiratory symptoms over 18 months . Repeated intermittent 28-day courses of AZLI treatment were well tolerated . Clinical benefits in pulmonary function , health-related quality of life , and weight were observed with each course of therapy . AZLI is a safe and effective new therapy in patients with CF and PA airway infection BACKGROUND Pulmonary exacerbations are associated with significant lung function decline from baseline in cystic fibrosis ( CF ) and it is not well understood why some patients do not respond to antibiotic therapy . The objective of this study was to identify factors associated with lung function response to antibiotic treatment of pulmonary exacerbations . METHODS As a secondary analysis of a r and omized , controlled trial of intravenous antibiotic treatment for pulmonary exacerbations in CF patients , we investigated whether baseline factors and changes in sputum bacterial density , serum or sputum inflammatory markers were associated with recovery of lung function and risk of subsequent exacerbation . RESULTS In 36 of the 70 exacerbations ( 51 % ) , patients ' lung function returned to > 100 % of their baseline at day 14 of antibiotic treatment ; 34 exacerbations were classified as non-responders . Baseline characteristics were not significantly different between responders and non-responders . Less of a drop in FEV1 from baseline to exacerbation ( OR 1.09 , 95 % CI 1.0 , 1.18 , p=0.04 ) as well as a greater decrease in sputum neutrophil elastase ( OR 2.94 , 95 % CI 1.07 , 8.06 , p=0.04 ) were associated with response to antibiotic treatment at day 14 . In addition , higher CRP ( HR 1.35 ( 95 % CI : 1.01 , 1.78 ) , p=0.04 ) and sputum neutrophil elastase ( HR 1.71 ( 95 % CI : 1.02 , 2.88 ) , p=0.04 ) at day 14 of antibiotic therapy were associated with an increased risk of subsequent exacerbation . CONCLUSIONS Inadequate reduction of inflammation during an exacerbation is associated with failure to recover lung function and increased risk of subsequent re-exacerbation in CF patients OBJECTIVE To assess the potential role of multiple bronchoalveolar lavages ( BALs ) in the treatment of children with lipoid pneumonia ( LP ) . MATERIAL S AND METHODS This prospect i ve study included 10 children ( 7 female , 3 male ) with LP secondary to mineral oil aspiration . The age ranged from 3 months to 7 years and 1 - 60 days history of mineral oil intake , with a 6 months clinic follow-up .  High-resolution computer tomography ( CT ) was performed 1 - 7 days prior to treatment and 2 - 20 days after the last therapeutic BAL , and review ed by two experienced chest radiologists . Oxygen saturation was measured with digital oximetry . Therapeutic BAL was performed weekly until BAL fluid was nearly transparent and the cell count returned to normal range values . RESULTS In all children , the initial CT scans showed multifocal bilateral consolidation involving mainly the dorsal and central regions . The areas of consolidation had foci of decreased attenuation in eight patients . Following a total of 4 - 10 therapeutic BALs , the CT scans returned to normal in 3 patients , improved considerably in 5 , and showed only slight improvement in 2 . Oxygen saturation increased from 88.8 + /- 3.4 % at presentation to 96.2 + /- 0.8 % after treatment ( P < 0.0001 ) . Multiple lavages  reduced ( P < 0.003 ) numbers of lipid-laden macrophages and restored BAL cellularity to normal range values . CONCLUSION Multiple therapeutic BAL of children with LP results in significant improvement of CT findings , oxygen saturation , restoration of BAL fluid cellularity and clinical recover without any evidence of respiratory distress at the end of treatment and 6 months after the last BAL We evaluated patients with cystic fibrosis ( CF ) and moderate obstructive lung disease in pulmonary exacerbation in a double-blind placebo-controlled trial to determine the contribution of antibiotic-mediated reduction in sputum bacterial density to clinical improvement . For the first 4 days of study , all patients received bronchodilating aerosols and chest physiotherapy but no antibiotics . During this time , the patients showed significant improvement in mean FVC , FEV1 , and maximal midexpiratory flow rate ( FEF25 - 75 ) . In 12 of 13 trials , the patients showed no significant increases in the density of Pseudomonas aeruginosa during these first 4 days . In these 12 trials , the patients were stratified by their initial FVC and r and omized to receive either parenteral tobramycin and ticarcillin ( n = 7 ) or placebo ( n = 5 ) , in addition to continued aerosol and chest physiotherapy . In the remaining trial , the patient had a significant rise in the density of P. aeruginosa and was assigned to the antibiotic group . During the next 14 days of therapy , the antibiotic group showed significantly ( p less than 0.01 ) greater reductions in log10 colony-forming units ( cfu ) of P. aeruginosa per gram of sputum and greater increases in FVC , FEV1 , and FEF25 - 75 than did the placebo group . The degree of decrease in 
    Output:
    
This study prospect ively assessed whether the use of multiple combination bactericidal antibiotic testing improved clinical outcomes in participants with acute pulmonary exacerbations of cystic fibrosis who were infected with multiresistant bacteria .
The quality of the evidence was moderate for the only outcome providing data solely for individuals with infection due to Pseudomonas aeruginosa .
The current evidence , limited to one study , shows that there is insufficient evidence to determine effect of choosing antibiotics based on combination antimicrobial susceptibility testing compared to choosing antibiotics based on conventional antimicrobial susceptibility testing in the treatment of acute pulmonary exacerbations in people with cystic fibrosis with chronic Pseudomonas aeruginosa infection .