***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 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 Bronchiectasis in adults is a chronic disorder associated with poor quality of life and frequent exacerbations in many patients . There have been no previous international guidelines . The European Respiratory Society guidelines for the management of adult bronchiectasis describe the appropriate investigation and treatment strategies determined by a systematic review of the literature . A multidisciplinary group representing respiratory medicine , microbiology , physiotherapy , thoracic surgery , primary care , methodology and patients considered the most relevant clinical questions ( for both clinicians and patients ) related to management of bronchiectasis . Nine key clinical questions were generated and a systematic review was conducted to identify published systematic review s , r and omised clinical trials and observational studies that answered these questions . We used the GRADE approach to define the quality of the evidence and the level of recommendations . The result ing guideline addresses the investigation of underlying causes of bronchiectasis , treatment of exacerbations , pathogen eradication , long term antibiotic treatment , anti-inflammatories , mucoactive drugs , bronchodilators , surgical treatment and respiratory physiotherapy . These recommendations can be used to benchmark quality of care for people with bronchiectasis across Europe and to improve outcomes . The publication of the first ERS guidelines for bronchiectasis Bronchiectasis is one of the most neglected diseases in respiratory medicine . There are no approved therapies and few large-scale , representative epidemiological studies . The EMBARC ( European Multicentre Bronchiectasis Audit and Research Collaboration ) registry is a prospect i ve , pan-European observational study of patients with bronchiectasis . The inclusion criterion is a primary clinical diagnosis of bronchiectasis consisting of : 1 ) a clinical history consistent with bronchiectasis ; and 2 ) computed tomography demonstrating bronchiectasis . Core exclusion criteria are : 1 ) bronchiectasis due to known cystic fibrosis ; 2 ) age < 18 years ; and 3 ) patients who are unable or unwilling to provide informed consent . The study aims to enrol 1000 patients by April 2016 across at least 20 European countries , and 10 000 patients by March 2020 . Patients will undergo a comprehensive baseline assessment and will be followed up annually for up to 5 years with the goal of providing high- quality longitudinal data on outcomes , treatment patterns and quality of life . Data from the registry will be available in the form of annual reports . and will be disseminated in conference presentations and peer- review ed publications . The European Bronchiectasis Registry aims to make a major contribution to underst and ing the natural history of the disease , as well as guiding evidence -based decision making and facilitating large r and omised controlled trials . The European Bronchiectasis Registry will recruit 10 000 patients over 5 years Aminoglycosides are a mainstay of therapy for patients with cystic fibrosis ( CF ) or non-CF bronchiectasis who are infected with Pseudomonas aeruginosa ( Psa ) . Traditionally , aerosolized antibiotics are delivered by liquid nebulization . The objective of this study was to determine whether a gentamicin dry powder inhaler ( DPI ) is as microbiologically active and potentially safe as gentamicin inhaled via a small-volume nebulizer ( SVN ) or given intravenously . The study was done according to a r and omized , single-dose , and triple crossover protocol . Ten patients with CF or non-CF bronchiectasis and chronically infected with Psa were recruited . Patients received a single dose of either gentamicin 160 mg via DPI or SVN , or gentamicin at 5 mg/kg by intravenous infusion . In seven of the 10 patients , the minimum inhibitory concentration ( MIC ) was achieved in sputum after DPI and SVN , with mean ( 95 % confidence interval ) gentamicin concentrations at 2 h after administration of 13.1 microgram/g sputum ( range : 2.2 to 23.9 microgram/g ) and 97.2 microgram/g sputum ( range : 0.3 to 194.2 microgram/g ) , respectively , whereas gentamicin levels in the sputum after intravenous administration failed to reach the MIC . Gentamicin given by DPI and SVN significantly decreased the sputum Psa density ( p < 0.05 ) , by almost one order of magnitude . No significant decline in bacterial counts was observed after intravenous gentamicin . When gentamicin was inhaled , blood concentrations were minimal , and were below concentrations known to cause systemic toxicity . For treatment of Psa infections susceptible to gentamicin , gentamicin administration by DPI appeared to be as efficient as by SVN , despite the delivery of a 7-fold lower dose to the airways RATIONALE Pseudomonas aeruginosa lung infection in patients with bronchiectasis , a chronic airway disease that is characterized by episodes of exacerbation , is associated with more severe disease and a higher utilization of health-care re sources . Inhaled tobramycin solution reduces the number of acute exacerbations in patients with cystic fibrosis (CF)-related bronchiectasis with P aeruginosa infection but remains untested in the treatment of exacerbations in patients with non-CF bronchiectasis . OBJECTIVES This study tested the effect of adding inhaled tobramycin solution to oral ciprofloxacin ( Cip ) for the treatment of acute exacerbations of non-CF bronchiectasis in patients with P aeruginosa infection . METHODS A double-blind , r and omized , active comparator , parallel- design study conducted at 17 study centers ( 5 in the United Kingdom , and 12 in the United States ) compared 2 weeks of therapy with Cip with either an inhaled tobramycin solution or placebo in 53 adults with known P aeruginosa infection who were having acute exacerbations of bronchiectasis . MEASUREMENTS Clinical symptoms , pulmonary function , clinical efficacy , and sputum microbiology were investigated prospect ively . MAIN RESULTS An inhaled solution of Cip with tobramycin , compared to placebo , achieved greater microbiological response but no statistically significant difference in clinical efficacy at days 14 or 21 . Clinical and microbiological outcomes at the test of cure ( ie , the clinical outcome assessment at day 21 ) were concordant when an inhaled tobramycin solution was added to therapy with Cip and compared to placebo ( p = 0.01 ) . Both subject groups had similar overall adverse event rates , but subjects receiving therapy with an inhaled tobramycin solution reported an increased frequency of wheeze ( 50 % ; placebo group , 15 % ) . CONCLUSIONS The addition of an inhaled tobramycin solution to therapy with oral Cip for the treatment of acute exacerbations of bronchiectasis due to P aeruginosa improved microbiological outcome and was concordant with clinical outcome ; the inability to demonstrate an additional clinical benefit may have been due to emergent wheeze result ing from treatment 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 
    Output:
    
There is currently no evidence indicating whether orally administered antibiotics are more beneficial compared to inhaled antibiotics .