Should inhaled tobramycin be recommended for the treatment of P aeruginosa infection in patients with bronchiectasis, but without cystic fibrosis? Based on the evidence, the routine use of inhaled tobramycin cannot be recommended at this time. The studies performed to date have been relatively small or have involved the short-term use of the drug. In addition, they have tended to look at different outcome measures (eg, symptomatic improvement, bacterial density, pulmonary function, and hospitalization) and have produced somewhat mixed results. This differs from the studies in cystic fibrosis patients that have almost uniformly shown a benefit from the treatment. In part, this may be a reflection of less homogeneity among non-cystic fibrosis patients with bronchiectasis. Of concern is the greater frequency of bronchospasm, often leading to a discontinuation of therapy, in the non-cystic fibrosis patients. As Scheinberg and Shore indicate, however, existing clinical trials, including their own, have primarily enrolled patients with advanced bronchiectasis, and patients with milder disease may tolerate inhaled antibiotics better.