***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 r and omized , open clinical trial was performed to compare azithromycin and amoxycillin/clavulanate potassium in children with acute otitis media with effusion . Patients were allocated to therapy with azithromycin ( 10 mg/kg once daily for 3 days ) or amoxycillin/clavulanate potassium ( 40 mg/kg/day divided into three equal doses for 10 days ) . Clinical examination and tympanometric evaluation were performed at baseline , and at day 3 to 5 , day 10 to 14 , day 28 to 30 and day 55 to 60 after the initiation of therapy . Tympanocentesis fluid cultures were collected at enrolment , and urine and blood sample s were obtained at baseline and at day 10 to 11 . Of 100 patients enrolled , 92 were considered evaluable .  Middle ear cultures were positive in 53.2 % of the patients ; the most common pathogens were Streptococcus pneumoniae ( 33 % ) and Haemophilus influenzae ( 33 % ) . The response was satisfactory in 47 ( 100 % ) patients treated with azithromycin and 42 ( 95.4 % ) patients receiving A/C. Rates of persistence of middle ear effusion were comparable . Nausea and loose stools were more common in children treated with amoxycillin/clavulanate potassium ( P < or = 0.02 ) . Based on the comparable efficacy noted in this study , the lower incidence of side-effects and the convenience of a shorter duration of treatment , azithromycin represents an attractive therapeutic alternative to amoxycillin/clavulanate potassium and should be further evaluated in larger-scale clinical trials including patients with penicillin-resistant organisms A double-blind controlled trial of cefroxadine ( CXD ) 250 mg t.i.d . was undertaken to objective ly evaluate its safety and effectiveness in the treatment of acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media , using cephalexin ( CEX ) 250 mg q.i.d . as a control drug , and the following results were obtained . In the treatment of acute suppurative otitis media , the 2 drugs produced almost equal outcomes , showing no significant difference in assessment s of both overall effects and usefulness . In the treatment of acute exacerbation of chronic suppurative otitis media , the 2 drugs exhibited no significant difference as well in overall effects by Wilcoxon 's two- sample test . However , the CEX group had significantly more nonresponsive patients , i.e. 35.5 % as compared with 9.7 % of the CXD group ( chi 2-test , P less than 0.05 ) . In the assessment of clinical usefulness as well , no significant difference was observed between the 2 groups . In the assessment of overall effects based on the patients whose isolated organisms were sensitive to the drugs , CEX group had more patients not responding to the treatment of acute exacerbation of chronic suppurative otitis media ( chi 2-test , P less than 0.05 ) . Bacteriological effects were not significantly different between the 2 drugs in both acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media . Overall safety rating was not significantly different between the 2 drugs . Side effects occurred as the symptoms of digestive organ in 2 patients each in both groups ( equally an incidence of 2.6 % ) . As for the improvement of each symptom after treatment ( assessed on day 3 ) , CXD was superior in the improvement rate of otorrhea volume as the main symptom of acute exacerbation of chronic suppurative otitis media , while CEX was superior in that of otoobstruction feeling . From the above findings , it is presumed that CXD is a safe drug which can exhibit equal or superior therapeutic effects to CEX in the treatment of acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media , at 3/4 of the CEX dose level An open multicentre study was conducted in 484 children between the ages of 6 months and 12 years with otitis media to compare the efficacy , the safety and the tolerance of once-daily azithromycin given for three days versus thrice-daily amoxicillin/clavulanic acid ( CA ) given for ten days . A satisfactory response ( cure plus improvement ) was noted 10 to 14 days after the start of treatment in 199 of 215 ( 92.6 % ) azithromycin-treated children and in 186 of 198 ( 93.9 % ) amoxicillin/CA-treated children . The relationship between treatment and clinical response was independent of chronicity of infection and the presence or absence of a perforated eardrum . Improvement in signs and symptoms of otitis media occurred significantly more rapidly in the children treated with azithromycin . Treatment-related or possibly treatment-related adverse events were recorded in 11 of 243 ( 4.5 % ) azithromycin-treated patients and in 20 of 240 ( 8.3 % ) treated with amoxicillin/CA . No patients in the azithromycin treatment group were withdrawn from treatment , but six amoxicillin/CA patients , including two < 2 years of age , discontinued treatment prematurely because of adverse events ; the difference between treatment groups was statistically significant ( p=0.0146 ) . It is concluded that azithromycin given as an oral suspension once daily for three days is as safe and effective as amoxicillin/CA given thrice daily for ten days in the treatment of children with otitis media ABSTRACT Infants and young children , especially those in day care , are at risk for recurrent or persistent acute otitis media ( AOM ) . There are no data on oral alternatives to high-dose amoxicillin-clavulanate for treating AOM in these high-risk patients . In this double-blind , double-dummy multicenter clinical trial , we compared a novel , high-dose azithromycin regimen with high-dose amoxicillin-clavulanate for treatment of children with recurrent or persistent AOM . Three hundred four children were r and omized ; 300 received either high-dose azithromycin ( 20 mg/kg of body weight once a day for 3 days ) or high-dose amoxicillin-clavulanate ( 90 mg/kg divided twice a day for 10 days ) . Tympanocentesis was performed at baseline ; clinical response was assessed at day 12 to 16 and day 28 to 32 . Two-thirds of patients were aged ≤2 years . A history of recurrent , persistent , or recurrent plus persistent AOM was noted in 67 , 18 , and 14 % of patients , respectively . Pathogens were isolated from 163 of 296 intent-to-treat patients ( 55 % ) . At day 12 to 16 , clinical success rates  for azithromycin and amoxicillin-clavulanate were comparable for all patients ( 86 versus 84 % , respectively ) and for children aged ≤2 years ( 85 versus 79 % , respectively ) . At day 28 to 32 , clinical success rates for azithromycin were superior to those for amoxicillin-clavulanate for all patients ( 72 versus 61 % , respectively ; P = 0.047 ) and for those aged ≤2 years ( 68 versus 51 % , respectively ; P = 0.017 ) . Per-pathogen clinical efficacy against Streptococcus pneumoniae and Haemophilus influenzae was comparable between the two regimens . The rates of treatment-related adverse events  for azithromycin and amoxicillin-clavulanate were 32 and 42 % , respectively ( P = 0.095 ) . Corresponding compliance rates were 99 and 93 % , respectively ( P = 0.018 ) . These data demonstrate the efficacy and safety of high-dose azithromycin for treating recurrent or persistent AOM In r and omized , double-blind trials of  antibiotic therapy for acute otitis media that determined both clinical and bacteriologic outcomes , clinical success rates were ( 93 % ) 236 of 253 for patients with bacteriologic success , ( 62 % ) 25 of 40 for those with bacteriologic failure , and ( 80 % ) 124 of 155 for those with nonbacterial acute otitis media . These rates were used to calculate the effectiveness of three strategies for assessing drug efficacy : ( 1 ) tympanocentesis and culture before and during therapy ( bacteriologic efficacy ) , ( 2 ) tympanocentesis before therapy and assessment of clinical efficacy  in bacterial acute otitis media , and ( 3 ) no tympanocentesis and assessment of clinical efficacy  in clinical ( total ) acute otitis media . For a drug with a bacteriologic efficacy of 100 % , calculated clinical efficacy was 93 % for bacterial acute otitis media and 89 % for clinical acute otitis media . For a drug with bacteriologic efficacy of 27 % , a rate consistent with no antibacterial therapy , efficacy was 71 % for bacterial acute otitis media and 74 % for clinical acute otitis media . We conclude that if efficacy is measured by symptomatic response , drugs with excellent antibacterial activity will appear less efficacious than they really are and drugs with poor antibacterial activity will appear more efficacious than they really are . The predominant phenomenon is that drugs with poor antibacterial activity will appear to be clinical ly effective in the treatment of acute otitis media Abstract Objective To assess the efficacy of three days versus five days of treatment with oral amoxicillin for curing non-severe pneumonia in children . Design R and omised , double blind , placebo controlled multicentre trial . Setting Outpatient departments of seven referral hospitals in India . Participants 2188 children aged 2 - 59 months , 1095 given three days of treatment and 1093 given five days . Intervention Oral amoxicillin 31 - 54 mg/kg/day in three divided doses . Main outcome measures Treatment failure : defined as development of chest indrawing , convulsions , drowsiness , or inability to drink at any time ; respiratory rate above age specific cut points on day 3 or later ; or oxygen saturation by pulse oximetry < 90 % on day 3 . Results The clinical cure rates with three days and five days of treatment were 89.5 % and 89.9 % , respectively ( absolute difference 0.4 ( 95 % confidence interval - 2.1 to 3.0 ) ) . Adherence to treatment regimen was 94 % and 85 % for three day and five day treatments , respectively . Loss to follow up was 5.4 % by day 5 . There were no deaths , 41 hospitalisations , and 36 minor adverse reactions . There were 225 ( 10.3 % ) clinical failures and 106 ( 5.3 % ) relapses , and rates were similar in both treatments . At enrolment , 513 ( 23.4 % ) children tested positive for respiratory syncytial virus , and Streptococcus pneumoniae and Haemophilus influenzae were isolated from the nasopharynx in 878 ( 40.4 % ) and 496 ( 22.8 % ) children , respectively . Clinical failure was associated with isolation of respiratory syncytial virus ( adjusted odds ratio 1.95 ( 95 % confidence interval 1.0 to 3.8 ) ) , excess respiratory rate of > 10 breaths/minute ( 2.89 ( 1.83 to 4.55 ) ) , and non-adherence with treatment at day 5 ( 11.57 ( 7.4 to 18.0 ) ) . Conclusions Treatment with oral amoxicillin for three days was as effective as for five days in children with non-severe pneumonia Abstract Two hundred and fifteen children aged 4 months–6 years with acute otitis media ( AOM ) were r and omized to be treated either by a single i.m . injection of ceftriaxone , 50 mg/kg , with a second dose in the event of unsatisfactory response after 48 h or a history of recurrent AOM ( 109 patients ) or amoxicillin clavulanate 12.5 mg tid ( 106 patients ) . The failure rate was similar in children treated by ceftriaxone and amoxicillin clavulanate , 4.6 % and 4.7 % , respectively ( st and ard error for intergroup difference −2.87 % , 95 % confidence interval −5.62 % to 5.87 % ) . No significant differences between the groups were found in the dynamics of the resolution of the acute symptomatology , otoscopy findings , relapse rate at 30 days or tympanographic evidence of middle ear effusion at the scheduled visits on days 30 , 60 and 90 . Recurrence of AOM between days 31 and 90 was observed significantly in more children treated with amoxicillin clavulanate than with ceftriaxone – 25 out of 84 ( 29.4 % ) versus 11 out of 81 ( 13.6 % ) ( P=0.012 ) . Conclusion Ceftriaxone injection(s ) is as efficient at least as 10-day oral amoxicillin clavulanate for 
    Output:
    
Conclusion There is no evidence of an increased risk of treatment failure with short course of antibiotics for acute otitis media .
Among the short-course regimens , azithromycin use was associated with a lower risk of treatment failure while short-acting oral antibiotics and parenteral ceftriaxone may be associated with a higher risk of treatment failure