***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: 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 A prospect i ve cohort study was conducted to analyze factors associated with  antibiotic noncompliance  and waste among patients suffering acute respiratory infection ( ARI ) and acute diarrhea ( AD ) . The study took place in four primary health care clinics in Mexico City , two belonging to the Ministry of Health ( MoH ) and two to the Mexican Social Security Institute ( IMSS ) . Two hundred twenty-two patients with ARI and 155 with AD were included . Data about study variables and the assessment of compliance were obtained through patient interviews and direct observation . Factors associated with noncompliance were assessed through a multiple logistic regression procedure . Noncompliance was 60 % for ARI and 55.5 % for AD in both health care systems . Prescription of an antibiotic was justified only in 13.5 % of cases . Associated factors were : increased duration of illness ( OR 2.95 ; 95 % CI , 1.17 - 7.41 ) ; complexity of the treatment : 3 or more doses per day ( OR 2.47 ; 95 % CI , 1.56 - 3.92 ) , and treatment for more than 7 days ( OR 1.94 ; 95 % CI , 1.16 - 3.26 ) ; younger age of patient ( OR 1.89 ; 95 % CI , 1.18 - 3.02 ) ; and an inadequate physician-patient relationship ( OR 1.87 ; 95 % CI , 1.16 - 3.02 ) . Antibiotic waste was higher in IMSS ( ARI 39.3 % , AD 32.6 % ) , than in the MoH ( ARI 21.2 % , AD 16.4 % ) . Educational strategies to modify physician prescribing practice s and strengthen physician-patient relationships might improve compliance and decrease drug waste The treatment of streptococcal pharyngitis with azithromycin ( 10 mg/kg orally once daily for 3 days ) or clarithromycin ( 7.5 mg/kg orally twice daily for 10 days ) was compared in a r and omized observer-blind study carried out in 174 children with documented Streptococcus pyogenes infection . The observed cure rate 10 days after the beginning of treatment was 61/63 ( 96.8 % ) in the clarithromycin group and 71/74 ( 95.9 % ) in the azithromycin group . At days 17 – 20 the bacteriological eradication rate was 95.2 % for clarithromycin and 94.6 % for azithromycin . When children who did not complete treatment were included in the analysis the eradication rate was higher for azithromycin ( 93.6 % compared with 82.9 % ; P < 0.05 ) ; the difference was due to better compliance with the azithromycin regimen The usefulness of clinical and laboratory findings for prediction of the presence of Group A streptococci on throat culture and of an increase in antistreptococcal antibodies  was investigated in 693 adult patients . Several findings were shown to increase the likelihood of streptococcal isolation , alone and in combination : tonsillar exu date , tonsillar enlargement , tender anterior cervical adenopathy , myalgias , and a positive throat culture in the preceding year . Compared with a frequency of 9.7 % in all patients , the probabilities of a positive culture were quite different ( ranging from 2 to 53 % ) in subgroups of patients with different combinations of these clinical findings . The results of a  leukocyte count and measurement of C-reactive protein added little additional predictive information . While clinical findings can never predict perfectly the results of a throat culture , they nevertheless can provide useful information — particularly in tending to “ rule out ” streptococcal infection — in adult patients with pharyngitis The safety and efficacy of clarithromycin was compared with those of amoxicillin-potassium calvulanate for the treatment of acute otitis media in children . In a multicenter , r and omized , investigator-blinded trial , 180 patients ( 6 months to 12 years of age ) with acute otitis media were allocated to receive either clarithromycin , 15 mg/kg in two divided doses ( n = 90 ) , or amoxicillin-clavulanate , 40 mg/kg in three divided doses ( n = 90 ) , for 10 days . Middle ear sample s were obtained by tympanocentesis from 175 of 180 patients . Pathogens were isolated from 137 sample s ( 76 % ) . Eighty-six patients in each treatment group were considered for efficacy analysis . Clinical cure or improvement was achieved within 4 days after treatment in 80 ( 93 % ) of 86 patients receiving clarithromycin and in 82 ( 95 % ) of 86 patients receiving amoxicillin-clavulanate .  Recurrence of infection was observed between 5 and 35 days after treatment in 9 ( 11 % ) of 80 patients in the clarithromycin group and in 8 ( 10 % ) of 82 patients in the amoxicillin-clavulanate group . Middle ear effusion was found with similar frequency at the end of therapy and at follow-up visits in both treatment groups . Mild gastrointestinal signs and symptoms , the most common side effects , were noted in 20 % and 52 % of patients in the clarithromycin group and the amoxicillin-clavulanate group , respectively ( p < 0.001 ) . We conclude that clarithromycin is a safe and effective antimicrobial agent for the treatment of acute otitis media in children & NA ; The safety and efficacy of a new oral suspension formulation of clarithromycin were evaluated in this multicenter , Phase III , single blind , comparative trial in 379 children ages 6 months to 12 years with signs or symptoms of acute otitis media . Children were r and omized to receive a 10‐day course of clarithromycin oral suspension ( 7.5 mg/kg ; maximum , 500 mg ) or cefaclor oral suspension ( 20 mg/kg ; maximum , 500 mg ) twice daily . Specific clinical response criteria were developed based on pretreatment signs and symptoms and results of tympanometry . Of the 379 enrolled patients 281 ( 74 % ) were evaluable ( clarithromycin , 150 ; cefaclor , 131 ) . There were no demographic differences between the two groups . Fifty percent of the patients had 2 to 4 episodes of otitis media ( including the current episode ) in the past 12 months ; 63 % of the patients had an infection of moderate severity . Clarithromycin and cefaclor suspensions were similarly effective for the treatment of acute otitis media . Clinical success ( cure , cure with effusion or improvement ) was achieved in 86 % of clarithromycin‐treated patients and 90 % of cefaclor‐treated patients . The majority of bacterial isolates for which susceptibility results were available were fully or moderately susceptible to the study drugs ( 96 % clarithromycin , 92 % cefaclor ) . Both drugs were welltolerated ; adverse events considered probably study drug‐related were reported by 30 ( 15 % ) of clarithromycin recipients and 31 ( 17 % ) of cefaclor recipients . There were no significant differences between the groups in the numbers of patients reporting events that were thought to be related to study medication . A 10‐day regimen of clarithromycin suspension ( 7.5 mg/kg twice daily ) appears to be as safe and effective as a 10‐day regimen of cefaclor suspension ( 20 mg/kg twice daily ) for the treatment of acute otitis media in children Objective . To compare the safety and efficacy of a short course ( 5 days ) of ceftibuten vs. azithromycin for 3 days for treatment of group A beta-hemolytic streptococcal ( GABHS ) pharyngitis in children . Methods . A multicenter , open label , prospect i ve , r and omized trial in which patients ≥3 to ≤16 years of age with proven GABHS pharyngitis were r and omized to receive either once daily ceftibuten for 5 days or azithromycin for 3 days . Patients were evaluated for clinical outcomes and /or for adverse events at days 6 to 8 , 13 to 15 and 33 to 35 posttherapy . Microbiologic assessment s ( pharyngeal cultures ) were conducted at baseline and at each follow-up visit . Results . A total of 132 patients in the ceftibuten arm and 116 in the azithromycin arm were enrolled in the safety analysis , whereas 126 and 101 , respectively , were enrolled for ceftibuten and azithromycin efficacy evaluation . Clinical success ( cure or marked amelioration ) at days 6 to 8 was recorded in 98 and 94 % in the 2 groups , respectively . In the bacteriologic efficacy analysis at 6 to 8 days , the GABHS strain was eradicated in 76 % of the patients treated with ceftibuten and in 76 % of those receiving azithromycin . At 33 to 35 days , 84 % of the patients in the ceftibuten arm and 71 % in the azithromycin arm were GABHS-negative , and bacteriologic relapse was observed in 4 and 7 % of the ceftibuten and azithromycin cases , respectively . Both treatments were well-tolerated by all patients . Conclusions . Ceftibuten and azithromycin allow simple treatment schedules ( i.e. once daily administration , short duration of treatment ) . The somewhat higher eradication rate recorded after ceftibuten administration is consistent with the overall superior bactericidal activity of beta-lactams compared with macrolides vs. GABHS in vitro Background : Short course antimicrobial therapy is suggested for group A streptococcal tonsillopharyngitis . Methods : The bacteriologic and clinical efficacies of clarithromycin [ 30 or 15 mg/kg/day twice daily ( b.i.d . ) ] or amoxicillin/clavulanate ( 43.8/6.2 mg/kg/day b.i.d . ) for 5 days or penicillin V ( 30 mg/kg/day 3 times a day ) for 10 days were compared . In a r and omized , open label , parallel group , multicenter study , 626 children ( 2–16 years old ) with tonsillopharyngitis were enrolled ; 537 were evaluable for efficacy . Follow-up evaluations were performed at 4–8 and 21–28 days after therapy . Results : At enrollment , 26 % of the Streptococcus pyogenes isolates were clarithromycin-nonsusceptible . All regimens had an apparently similar clinical efficacy . The long term S. pyogenes eradication rates were 102 of 123 ( 83 % ) with amoxicillin/clavulanate and 88 of 114 ( 77 % ) with penicillin V. In the 30- and 1 
    Output:
    
High quality evidence showed that Clarithromycin is a safe and effective alternative for the treatment of URIs in pediatric patients .
Is superior to other antibiotics in relation to bacterial eradication .