A clinical study published in the Journal of the American Medical Association (JAMA) in 2013 showed that in patients with non-cystic fibrosis (CF) bronchiectasis, azithromycin improves symptoms but also increases the risk of antibiotic resistance. The randomized placebo-controlled trial, conducted in 14 hospitals in the Netherlands from 2008 to 2010, enrolled 83 outpatients with bronchiectasis not due to CF who were randomized to receive azithromycin (250 mg daily) or placebo for 12 months. As a result, 43 (52%) patients received azithromycin and the other 40 (48%) patients received placebo. After one year, 80% of patients in the placebo group had at least one exacerbation during the study observation period, compared with 46.5% in the treatment group, and azithromycin reduced the absolute risk of disease exacerbation by 33.5%. Gastrointestinal adverse reactions occurred in approximately 40% of patients treated with azithromycin but did not require discontinuation of the drug, compared with 5% in the placebo group. Macrolide resistance was seen in 88% of the treatment group, compared with 26% of the placebo group. The authors of this study concluded that azithromycin is effective in reducing the progression of non-cystic fibrosis bronchiectasis, improving lung function and improving quality of life, but also has gastrointestinal adverse effects and a high rate of drug resistance.