***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: Abstract Objective : To determine the effect of antibiotic treatment for acute otitis media in children between 6 months and 2 years of age . Design : Practice based , double blind , r and omised , placebo controlled trial . Setting : 53 general practice s in the Netherl and s. Subjects : 240 children aged 6 months to 2 years with the diagnosis of acute otitis media . Intervention : Amoxicillin 40 mg/kg/day in three doses . Main outcome measures : Persistent symptoms at day four and duration of fever and pain or crying , or both . Otoscopy at days four and 11 , tympanometry at six weeks , and use of analgesic . Results : Persistent symptoms at day four were less common in the amoxicillin group ( risk difference 13 % ; 95 % confidence interval 1 % to 25 % ) . The median duration of fever was two days in the amoxicillin group versus three in the placebo group ( P=0.004 ) . No significant difference was observed in duration of pain or crying , but analgesic consumption was higher in the placebo group during the first 10 days ( 4.1 v 2.3 doses , P=0.004 ) . In addition , no otoscopic differences were observed at days four and 11 , and tympanometric findings at six weeks were similar in both groups . Conclusions : Seven to eight children aged 6 to 24 months with acute otitis media needed to be treated with antibiotics to improve symptomatic outcome at day four in one child . This modest effect does not justify prescription of antibiotics at the first visit , provided close surveillance can be guaranteed Objective : To describe NP and AOM otopathogens during the time frame 2007 to 2009 , 6 to 8 years after the introduction of 7-valent pneumococcal conjugate ( PCV7 ) in the United States and to compare nasopharyngeal ( NP ) colonization and acute otitis media ( AOM ) microbiology in children 6 to 36 months of age having first and second AOM episodes with children who are otitis prone . Methods : Prospect ively , the microbiology of NP colonization and AOM episodes was determined in 120 children with absent or infrequent AOM episodes . NP sample s were collected at 7 routine visits between 6 and 30 months of age and at the time of AOM . For first and subsequent AOM episodes , middle ear fluid ( MEF ) was obtained by tympanocentesis . Eighty otitis prone children were comparatively studied . All 200 children received age-appropriate doses of PCV7 . Results : We found PCV7 serotypes were virtually absent : ( 0.9 % isolated from both NP and MEF ) in both study groups . However , non-PCV7 serotypes replaced PCV serotypes such that the frequency of isolation of S. pneumoniae ( Spn ) was nearly equal to that of non-typeable Haemophilus influenzae ( NTHi ) . M. catarrhalis ( Mcat ) was less common and Staphylococcus aureus infrequent in the NP and MEF from the 2 groups . The proportion of Spn , NTHi and Mcat causing AOM was similar in children with first and second AOM episodes compared to otitis prone children . However , oxacillin-resistant Spn isolated from the NP and MEF was 19 % for the absent/infrequent and 58 % for the otitis prone groups , P < 0.0001 . Beta-lactamase producing NTHi occurred more frequently in the otitis prone group , P = 0.04 . Conclusions : Six to 8 years after widespread use of PCV7 , Spn strains expressing vaccine-type serotypes have virtually disappeared from the NP and MEF of vaccinated children . NP colonization and AOM has changed to non-PCV7 strains of Spn . NTHi continues to be a major AOM pathogen . The otopathogens in first and second AOM and in otitis prone children are very similar although Spn and NTHi are more often antibiotic resistant in the otitis prone Background : The value of tympanometry in detection of middle ear effusion ( MEE ) has been widely studied in otitis media with effusion . There has been no direct comparison of tympanometric and tympanocentesis ( TAP ) findings in acute otitis media ( AOM ) . We compared otoscopic , tympanometric and TAP findings in AOM including cases of AOM without effusion . Methods : In a study of AOM treatment of 90 children , a tympanogram was obtained , and TAP was performed before and after 5 days of treatment . Subjects were followed with otoscopy and tympanometry every 2 weeks for 3 months or until the MEE cleared . Results : In 130 AOM ears , otoscopic , tympanometric and TAP findings were available ; MEE was obtained from 110 ears . Of 20 ears with a dry tap , 18 had abnormal tympanogram and otoscopic findings . With TAP findings as the st and ard , sensitivity and positive predictive value of type B tympanogram were 97 and 87 % , respectively . Of 18 AOM ears yielding dry tap , 2 yielded MEE 5 days later , and 8 continued with evidence of MEE 5 days–12 weeks later . Five subjects with 8 AOM ears yielding dry tap were lost to follow-up ; all had short duration of clinical symptoms . Conclusions : Although otoscopic and tympanometric findings suggested the presence of MEE in AOM , MEE was unobtainable by TAP in 14 % of cases . Dry tap cases likely represent early AOM before accumulation of detectable MEE . However , technical difficulty in obtaining small amounts of or highly viscous MEE could not be excluded . Sensitivity and positive predictive value of abnormal tympanograms in detection of MEE in AOM cases are comparable with those in otitis media with effusion BACKGROUND All but 2 of the 15 published trials have failed to show a difference in efficacy between short ( 3 to 5 days ) and st and ard ( 7 to 10 days ) antibiotic regimens for acute otitis media ( AOM ) . These studies involved relatively few patients under 2 years of age , who are at a higher risk for treatment failure . METHODS In a prospect i ve , comparative , double-blind , r and omized , multicenter trial , we compared amoxicillin/clavulanate in 3 divided doses for 10 days with an identical 5-day regimen , followed by a 5-day placebo period . RESULTS Between February 1995 and May 1996 , 385 children ( mean age , 13.3 months ) were enrolled , 194 in the 5-day treatment group and 191 in the 10-day treatment group . In the per protocol analysis , clinical success was obtained on days 12 to 14 after the beginning of treatment ( main analysis ) in 125 ( 76.7 % ) of the 163 children receiving the 5-day regimen and 148 ( 88.1 % ) of the 168 receiving the 10-day regimen ( P = .006 ) . Clinical success persisted on days 28 to 42 among 57 ( 40.4 % ) of the 141 assessable patients in the 5-day group and 64 ( 46 % ) of the 139 assessable patients in the 10-day group . ( P = .34 ) . Multivariate analysis showed that the 10-day course was statistically superior only among children cared for outside their homes ( 86.8 % vs 70.8 % ; P = .008 ) . CONCLUSIONS When assessed on days 12 to 14 after the outset of treatment , a 5-day regimen is not equivalent to a 10-day regimen among young children with AOM BACKGROUND Pneumococcal conjugate vaccine prevents recurrent acute otitis media ( AOM ) in infants immunised at 2 , 4 , 6 , and 12 - 15 months of age . We aim ed to find out whether this vaccine also prevents AOM in older children who have had previous episodes of AOM . METHODS In this double-blind , r and omised study , we enrolled 383 patients aged 1 - 7 years who had had two or more episodes of AOM in the year before entry . R and omisation was stratified in four groups according to age ( 12 - 24 months vs 25 - 84 months ) and the number of previous AOM episodes ( two or three episodes vs four or more episodes ) . Children received either 7-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal polysaccharide vaccine , or hepatitis A or B vaccines . They were followed up for 18 months for recurrence of AOM . We also cultured sample s of middle-ear fluid and nasopharyngeal swabs to assess association of pneumococcal serotypes with AOM after vaccination . FINDINGS We noted no reduction of AOM episodes in the pneumococcal vaccine group compared with controls ( intention-to-treat analysis : rate ratio 1.25 , 95 % CI 0.99 - 1.57 ) . Although nasopharyngeal carriage of pneumococci of serotypes included in the conjugate-vaccine was greatly reduced after pneumococcal vaccinations , immediate and complete replacement by non-vaccine pneumococcal serotypes took place . INTERPRETATION These data do not lend support to the use of pneumococcal conjugate vaccine to prevent otitis media in previously unvaccinated toddlers and children with a history of recurrent AOM Objective . The widespread use of antibiotics for treatment of acute otitis media ( AOM ) has result ed in the emergence of multidrug-resistant pathogens that are difficult to treat . However , it has been shown that most children with nonsevere AOM recover without ABX . The objective of this study was to evaluate the safety , efficacy , acceptability , and costs of a non-ABX intervention for children with nonsevere AOM . Methodology . Children 6 months to 12 years old with AOM were screened by using a novel AOM-severity screening index . Parents of children with nonsevere AOM received an educational intervention , and their children were r and omized to receive either immediate antibiotics ( ABX ; amoxicillin plus symptom medication ) or watchful waiting ( WW ; symptom medication only ) . The investigators , but not the parents , were blinded to enrollment status . Primary outcomes included parent satisfaction with AOM care , resolution of symptoms , AOM failure/recurrence , and nasopharyngeal carriage of Streptococcus pneumoniae strains resistant to ABX . Secondary outcomes included medication-related adverse events , serious adverse events , unanticipated AOM-related office and emergency department visits and telephone calls , the child 's absence from day care or school result ing from AOM , the parent 's absence from school or work because of their child 's AOM , and costs of treatment . Subjects were defined as failing ( days 0–12 ) or recurring ( days 13–30 ) if they experienced a higher AOM-severity score on reexamination . Results . A total of 223 subjects were recruited : 73 % were nonwhite , 57 % were < 2 years old , 47 % attended day care , 82 % had experienced prior AOM , and 83 % had not been fully immunized with heptavalent pneumococcal vaccine . One hundred twelve were r and omized to ABX , and 111 were r and omized to WW . Ninety-four percent of the subjects were followed to the 30-day end point . Parent satisfaction with AOM care was not different between the 2 treatment groups at either day 12 or 30 . Compared with WW , symptom scores on days 1 to 10 resolved faster in subjects treated with immediate ABX . At day 12 , among the immediate-ABX group , 69 % of tympanic membranes and 25 % of tympanograms were normal , compared with 51 % of normal tympanic membranes and 10 % of normal tympanograms in the WW group . Parents of children in the ABX group gave their children fewer doses of pain medication than did parents of children in the WW group . Subjects in the ABX group experienced 16 % fewer failures than subjects in the WW group . Of the children in the WW group , 66 % completed the study without needing ABX . Immediate ABX result ed in eradication of S pneumoniae carriage in the majority of children , but S pneumoniae strains cultured from children in the ABX group at day 12 were more likely to be multidrug-resistant than strains from children in the WW group . More  ABX-related adverse events were noted in the ABX group , compared with the WW group . No serious AOM-related adverse events were observed in either group . Office and emergency department visits , phone calls , and days of work/school missed were not different between groups . Prescriptions for ABX  were reduced by 73 % in the WW group compared with the ABX group . Costs of ABX  averaged $ 47.41 per subject in the ABX group and $ 11.43 in the WW group . Conclusions . Sixty-six percent of subjects in the WW group completed the study without ABX .  Parent satisfaction was the same between groups regardless of treatment . Compared with WW , immediate ABX treatment was associated with decreased numbers of treatment failures and improved symptom control but increased  ABX-related adverse events and a higher percent carriage of multidrug-resistant S pneumoniae strains in the nasopharynx at the day-12 visit . Key factors in implementing a WW strategy were ( a ) a method to classify AOM severity ; ( b ) parent education ; ( c ) management of AOM symptoms ; ( d ) access to follow-up care ; and ( e ) use of an effective 
    Output:
    
Meta-analyses in general showed no significant differences in antibiotic comparative effectiveness .
Antibiotics are modestly more effective than no treatment but cause adverse effects in 4 % to 10 % of children .
Most antibiotics have comparable  clinical success