***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: In this double-blind , parallel-group , multicenter study , 169 patients with symptoms of maxillary sinusitis but without radiographically confirmed empyema ( pus ) were r and omly assigned to receive either 500 mg azithromycin once daily for 3 days ( 87 patients ) or placebo daily for 3 days ( 82 patients ) . Nasal secretion , maxillary tenderness and pain , nasal obstruction , general malaise , and hyposmia were assessed at the start of the study and on days 4 , 11 , and 25 of treatment . After 11 days 58 % of the patients in the azithromycin group were cured versus 31 % in the placebo group ; after 25 days the cure rate was 79 % versus 67 % , respectively . When both cure and improvement were considered , the corresponding figures after day 25 were 90 % and 88 % , respectively . Adverse events , predominantly gastrointestinal , occurred in 24 ( 27 % ) of the azithromycin-treated patients and in 15 ( 18 % ) of those treated with placebo , but the difference was not statistically significant . There was a difference in efficacy in favor of azithromycin in the treatment of rhinitis with symptoms of maxillary sinusitis but without radiological signs of empyema ( pus ) . Antibiotics should only be used to alleviate symptoms in patients with moderate to severe symptoms , as the results after 25 days for both improvement and cure are equal . In the treatment of acute rhinitis with symptoms and signs of maxillary sinusitis but without empyema , treatment with azithromycin seems to result in a better cure rate after 10–12 days when compared with placebo OBJECTIVE To compare the efficacy of amoxicillin vs placebo in patients with an acute upper respiratory tract infection and purulent rhinorrhea . STUDY DESIGN Double-blind r and omized placebo-controlled trial . POPULATION The 416 patients included from 69 family practice s were 12 years or older , presenting with acute upper respiratory complaints , and having a history of purulent rhinorrhea and no signs of complications of sinusitis . OUTCOMES MEASURED Therapy success ( disappearance of symptoms that most greatly affected the patient 's health ) at day 10 and duration of general illness , pain , and purulent rhinorrhea . RESULTS Therapy was successful in 35 % of patients with amoxicillin and in 29 % of patients with placebo ( relative risk [ RR ] 1.14 , 95 % confidence interval [ CI ] , 0.92 - 1.42 ) . There was no effect on duration of general illness or pain . Duration of purulent rhinorrhea was shortened by amoxicillin ( 9 days vs 14 for clearing of purulent rhinorrhea in 75 % of patients ; P = .007 ) . Diarrhea was more frequent with amoxicillin ( 29 % vs 19 % , RR 1.28 , 95 % CI , 1.05 - 1.57 ) . No complications were reported . One patient ( 0.5 % ) receiving amoxicillin and 7 ( 3.4 % ) receiving placebo discontinued trial therapy because of exacerbation of symptoms ( RR 0.25 , 95 % CI 0.04 - 1.56 , P = .07 ) . All 8 patients recovered with antibiotic therapy . CONCLUSIONS Amoxicillin has a beneficial effect on purulent rhinorrhea caused by an acute infection of the nose or sinuses but not on general recovery . The practical implication is that all such patients , whatever the suspected diagnosis , can be safely treated with symptomatic therapy and instructed to return if symptoms worsen BACKGROUND Sinusitis is the fifth most common reason for patients to visit primary care physicians , yet clinical outcomes relevant to patients are seldom studied . OBJECTIVE To determine whether patients with purulent rhinitis , " sinusitis-type symptoms , " improved with antibiotics . Second , to examine a clinical prediction rule to provide preliminary validation data . METHODS Prospect i ve clinical trial , with double-blinded placebo controlled r and omization . The setting was a suburb of Washington , DC , from Oct 1 , 2001 , to March 31 , 2003 . All participants were 18 years or older , presenting to a family practice clinic with a complaint of sinusitis and with pus in the nasal cavity , facial pressure , or nasal discharge lasting longer than 7 days . The main outcome measures were resolution of symptoms within a 14-day follow-up period and the time to improvement ( days ) . RESULTS After exclusion criteria , 135 patients were r and omized to either placebo ( n=68 ) or amoxicillin ( n=67 ) for 10 days . Intention-to-treat analyses showed that 32 ( 48 % ) of the amoxicillin group vs 25 ( 37 % ) of the placebo group ( P=.26 ) showed complete improvement by the end of the 2-week follow-up period ( relative risk=1.3 ; 95 % confidence interval [ CI ] , 0.87 - 1.94 ] ) . Although the rates of improvement were not statistically significantly different at the end of 2 weeks , the amoxicillin group improved significantly earlier , in the course of treatment , a median of 8 vs 12 days , than did the placebo group ( P=.039 ) . CONCLUSION For most patients with sinusitis-type complaints , no improvement was seen with anti-biotics over placebo . For those who did improve , data suggested there is a subgroup of patients who may benefit from antibiotics Summary In 50 adults with bacterial sinusitis , cyclacillin ( 1500 mg . per day for 7 days ) proved significantly more effective than placebo in eliminating the signs and symptoms and in eradicating the causative microorganisms , ( Staphylococcus aureus , Proteus mirabilis , and Staph , epidermidis were most frequently isolated in this series ) . Sixty percent of the cultures in the cyclacillin series were sterilized , compared with only 10 % in the placebo series . Globally , 93 % of the cyclacillin-treated patients and only 55 % of the placebo-treated patients were considered improved . Of the P. mirabilis strains encountered , 72 % were eradicated by cyclacillin ( only 40 % by placebo ) despite the relatively high cyclacillin M.I.C.s for this microorganism ( 50 to 100 μg/ml . ) . Cyclacillin was much more effective in treating human sinusitis  than would have been anticipated from the M.I.C.s alone Sc and J Prim Health Care 2003;21:00 - 00 . ISSN 0281 - 34323 Objectives r - r To compare antibiotics and placebo in patients with clinical ly diagnosed acute maxillary sinusitis ( AMS ) . To study whether sinus ultrasound examination would help to detect those patients who benefit from antibiotic therapy . Design r - r A double-blind , r and omised , placebo-controlled multicentre trial . Setting r - r Nine primary care sites in Finl and . Subjects r - r 150 adult patients ( mean age 39.7 years ) with a clinical diagnosis of sinusitis . Intervention r - r Antibiotics ( amoxicillin 750 mg 2 2 , doxycycline 100 mg 2 2 or penicillin V 1500 mg 2 2 ) or placebo twice daily for 7 days ; all patients were examined with sinus ultrasound after r and omisation . Main outcome measure r - r Clinical success ( patients ' report of recovery ) in telephone interview at 2 weeks . Results r - r A total of 146 patients completed the 2-week follow-up . Patients receiving antibiotics achieved a slightly higher rate of clinical success than patients receiving placebo ( 80 % vs 66 % ; p=0.068 ) . Conclusions r - r Antibiotics hasten symptom relief in AMS . Yet many patients recover in 2 weeks without antimicrobial treatment . Only half of patients with a clinical diagnosis of AMS have sinusitis in ultrasound examination Abstract Objective : To compare the effectiveness of penicillin V and amoxycillin with placebo in treatment of adult patients with acute sinusitis . Design : R and omised , double blind , placebo controlled trial . Setting : Norwegian general practice . Subjects : 130 adult patients with a clinical diagnosis of acute sinusitis confirmed by computed tomography . Main outcome measures : Subjective status after three and 10 days of treatment , difference in clinical severity score between day 0 and day 10 as evaluated by the general practitioner , difference in score from computed tomography on day 0 and day 10 , and duration of sinusitis . Results : Amoxycillin and penicillin V led to significantly faster and better recovery than placebo . By day 10 , 71 patients receiving antibiotic treatment ( 86 % ) considered themselves to be recovered or much better compared with 25 ( 57 % ) receiving placebo . The mean ( 95 % confidence interval ) reductions in clinical severity scores by day 10 were 5.4 ( 5.0 to 5.8 ) for penicillin V , 5.5 ( 4.9 to 6.0 ) for amoxycillin , and 3.4 ( 2.8 to 4.0 ) for placebo . For the antibiotic groups combined the number of patients with the greatest degree of improvement on computed tomography ( scale 0 - 16)—that is , score 5 - 16 on day 10—was 31/83 ( 37 % ) compared with 10/44 ( 23 % ) receiving placebo . The median duration of the sinusitis was nine days in the amoxycillin group , 11 days in the penicillin V group , and 17 days in the placebo group . Conclusion : Penicillin V and amoxycillin are significantly more effective than placebo in the treatment of acute sinusitis . Key messages The median duration of sinusitis with different treatment was nine days for amoxycillin , 11 days for penicillin V , and 17 days for placebo More than half of the patients receiving antibiotic treatment reported side effects but few gave severe discomfort Half of the patients receiving placebo tablets felt restored or much better after 10 BACKGROUND Acute rhinosinusitis is one of the most common reasons for prescribing antibiotics in primary care . However , it is not clear whether antibiotics improve the outcome for patients with clinical ly diagnosed acute rhinosinusitis . We evaluated the effect of a combination product of amoxicillin-potassium clavulanate on adults with acute rhinosinusitis that was clinical ly diagnosed in a general practice setting . METHODS We conducted a r and omized , placebo-controlled , double-blind trial with 252 adults recruited at 24 general practice s and 2 outpatient clinics . Each patient had a history of purulent nasal discharge and maxillary or frontal pain for at least 48 hours . Patients were given amoxicillin , 875 mg , and clavulanic acid , 125 mg , or placebo twice daily for 6 days . Main outcome measures were time to cure ( primary outcome ) , number of days during which rhinosinusitis restricted activities at home or work , and frequency of adverse effects ( secondary outcomes ) . RESULTS The adjusted hazard ratio for the effect of amoxicillin-clavulanate was 0.99 ( 95 % confidence interval [ CI ] , 0.68 - 1.45 ) on time to cure and 1.28 ( 95 % CI , 0.80 - 2.05 ) in the prespecified subgroup of patients with a positive rhinoscopy result . At 7 days the mean difference between amoxicillin-clavulanate and placebo was -0.29 ( 95 % CI , -0.93 to 0.34 ) in the number of days with restrictions due to rhinosinusitis and -0.60 ( 95 % CI , -1.41 to 0.21 ) in patients with a positive rhinoscopy result . At 7 days patients who took amoxicillin-clavulanate were more likely to have diarrhea ( odds ratio , 3.89 ; 95 % CI , 2.09 - 7.25 ) . CONCLUSIONS Adult patients in general practice with clinical ly diagnosed acute rhinosinusitis experience no advantage with antibiotic treatment with amoxicillin-clavulanate and are more likely to experience adverse effects We compared the efficacy of penicillin V and amoxycillin treatment with placebo in 70 adult patients from Norwegian family practice with a clinical diagnosis of acute sinusitis and mucosal thickening on CT , but without fluid level or total opacification . The study was r and omized and double-blind . Three different outcomes were evaluated ; subjective status after 10 days of treatment , difference in clinical score between day 0 and day 10 , and duration of the illness episode .  Amoxycillin and penicillin V gave no better response to treatment than placebo , evaluated by all three outcome measures . The median duration of the sinusitis episode was 10 days in the amoxycillin- and placebo groups and 13 days in the penicillin-V group . In patients with a clinical diagnosis of acute sinusitis , fluid level and total opacification on CT are good criteria to differentiate between groups of patients that need or do not need antibiotic treatment Abstract The aim of the present study was to assess the hypothesis 
    Output:
    
Compared to placebo , antibiotic treatment relieves symptoms in a significantly higher proportion of patients within the first days of treatment .
Reporting an overall average treatment efficacy may underestimate treatment benefits in patients with a self-limiting illness