***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 the treatment of acute maxillary sinusitis , azithromycin offers an advantage over phenoxymethylpenicillin in that a complete course of treatment requires drug administration once daily for only three days . In this double-blind , parallel-group , multicenter study , 438 patients with radiographically verified maxillary sinusitis were r and omly assigned to receive either 500 mg azithromycin once daily for three days ( 221 patients ) or 1.3 g phenoxymethylpenicillin three times daily for ten days ( 217 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 51 % in the penicillin group ; after 25 days the cure rate was 79 % versus 76 % , respectively . When both cure and improvement were considered , the corresponding figures after 11 days were 97 % ( azithromycin ) and 95 % ( penicillin ) ; after 25 days they were 92 % and 88 % , respectively . Adverse events , predominantly gastrointestinal , occurred in 73 ( 33 % ) of the azithromycin-treated patients and in 87 ( 40.1 % ) of those treated with penicillin . No difference in efficacy was found between the two drugs in the treatment of acute maxillary sinusitis , and the adverse effects were comparable . The short duration of treatment with azithromycin offers a significant advantage over treatment with phenoxymethylpenicillin Respiratory tract pathogens ( beta-haemolytic streptococci groups A , C and G , Haemophilus influenzae , Branhamella catarrhalis or pneumococci ) , were isolated from nasopharyngeal and /or throat swabs in 73/138 ( 53 % ) patients greater than 10 years of age with a clinical diagnosis of acute sinusitis , acute tonsillitis , purulent nasopharyngitis or acute bronchitis . Serological evidence of a viral infection ( influenza A and B , parainfluenza 1 , 2 and 3 , respiratory syncytial virus , adenovirus ) or Mycoplasma pneumoniae infection was found in 10 % of the patients . The serum content of C-reactive protein ( S-CRP ) was increased ( greater than 12 mg/l ) in 26/33 ( 79 % ) patients with streptococci and in 22/59 ( 37 % ) patients without respiratory tract bacteria . In patients with a serological evidence of a virus tonsillitis , the S-CRP was also high ( 32 - 64 mg/l ) . At follow-up 10 - 12 days after the first visit , the clinical effect of erythromycin and penicillin V was judged to be similar ( 90 % clinical effect ) . Relapse or re-infection with group A streptococci were seen in 7 patients ( 4 on erythromycin , 3 on penicillin ) . In another 6 patients ( 3 on erythromycin , 3 on penicillin ) , antibiotic treatment was switched owing to persisting symptoms , probably due to H. Influenzae infection in 3 cases . The patients ' own estimates of their symptoms suggested treatment with erythromycin to have a more rapid effect than treatment with penicillin OBJECTIVE : Data suggest that subjects with irritable bowel syndrome are more likely to report a recent course of antibiotics . This study tests the hypothesis that a course of antibiotics is a risk factor for an increase in the number of functional bowel complaints over a 4-month period in a general population sample . METHODS : We initiated a prospect i ve case-control study in three general practice s in South London . Consecutive patients aged 16–49 attending their general practitioner with non-GI complaints and given a prescription for antibiotics were invited to participate . Comparison subjects who had not had antibiotics for 1 yr were identified from the practice records by age group , gender , and previous general practitioner visits . Fifty-eight antibiotic and 65 control patients agreed to participate . Question naires covering demographic , GI , and psychological data were sent at recruitment and at 4 months . Seventy-four percent of subjects completed the study . The number of symptoms at follow-up compared to that at recruitment . RESULTS : Twenty of 42 antibiotic subjects ( 48 % ) versus 11/49 control subjects ( 22 % ) demonstrated one or more additional functional bowel symptoms at 4 months ( unadjusted odds ratio = 3.14 [ 1.27–7.75 ] ) ( χ2= 6.4 , p = 0.01 ) . Ten of 42 antibiotic subjects ( 24 % ) versus 3/49 control subjects ( 6 % ) demonstrated two or more additional functional bowel symptoms at 4 months ( unadjusted odds ratio = 4.79 [ 1.22–18.80 ] ) ( χ2= 5.8 , p = 0.02 ) . CONCLUSIONS : Functional bowel symptoms come and go , but subjects who are given a course of antibiotics are more than three times as likely to report more bowel symptoms 4 months later than controls PURPOSE To compare the efficacy and tolerability of a 3-day course of azithromycin with a 10-day course of amoxicillin/clavulanic acid in the treatment of acute sinusitis in adults . PATIENTS AND METHODS One hundred adult patients with acute sinusitis were included in an open , r and omized study . Clinical diagnosis of sinusitis was confirmed by nasal endoscopy , sinus radiography , and ( when possible ) by culture of sinus aspirate . Patients were r and omized to receive azithromycin ( 500 mg once daily for 3 days ) or amoxicillin/clavulanate ( 625 mg every 8 hours for 10 days ) . RESULTS A significantly faster resolution of signs and symptoms of sinusitis was observed in the azithromycin-treated patients . By the end of therapy ( days 10 - 12 ) , 95 % of the patients in the azithromycin group and 74 % in the amoxicillin/clavulanate group were cured . The remaining patients ' conditions were improved . By the follow-up visit , cure was achieved in 98 % of the azithromycin-treated patients , and 91 % of the amoxicillin/clavulanate-treated patients . Treatment failure was observed in three patients from the amoxicillin/clavulanate group , and relapse occurred in one patient from each group . Bacteriologic eradication was achieved in 23 of 23 and 21 of 24 patients treated with azithromycin and amoxicillin/clavulanate , respectively . Both drugs were well tolerated . Two patients ( 4 % ) from the azithromycin group and five patients ( 10 % ) from the amoxicillin/clavulanate group reported mild gastrointestinal disturbances . CONCLUSIONS In adults with acute sinusitis , a 3-day course of azithromycin was as effective and well tolerated as a 10-day course of amoxicillin/clavulanic acid . A significantly simpler dosage regimen and faster clinical effect were the advantages of azithromycin CONTEXT Evidence to support antibiotic treatment for acute rhinosinusitis is limited , yet antibiotics are commonly used . OBJECTIVE To determine the incremental effect of amoxicillin treatment over symptomatic treatments for adults with clinical ly diagnosed acute rhinosinusitis . DESIGN , SETTING , AND PARTICIPANTS A r and omized , placebo-controlled trial of adults with uncomplicated , acute rhinosinusitis were recruited from 10 community practice s in Missouri between November 1 , 2006 , and May 1 , 2009 . INTERVENTIONS Ten-day course of either amoxicillin ( 1500 mg/d ) or placebo administered in 3 doses per day . All patients received a 5- to 7-day supply of symptomatic treatments for pain , fever , cough , and nasal congestion to use as needed . MAIN OUTCOME MEASURES The primary outcome was improvement in disease-specific quality of life after 3 to 4 days of treatment assessed with the Sinonasal Outcome Test-16 ( minimally important difference of 0.5 units on a 0 - 3 scale ) . Secondary outcomes included the patient 's retrospective assessment of change in sinus symptoms and functional status , recurrence or relapse , and satisfaction with and adverse effects of treatment . Outcomes were assessed by telephone interview at days 3 , 7 , 10 , and 28 . RESULTS A total of 166 adults ( 36 % male ; 78 % with white race ) were r and omized to amoxicillin ( n = 85 ) or placebo ( n = 81 ) ; 92 % concurrently used 1 or more symptomatic treatments ( 94 % for amoxicillin group vs 90 % for control group ; P = .34 ) . The mean change in Sinonasal Outcome Test-16 scores was not significantly different between groups on day 3 ( decrease of 0.59 in the amoxicillin group and 0.54 in the control group ; mean difference between groups of 0.03 [ 95 % CI , -0.12 to 0.19 ] ) and on day 10 ( mean difference between groups of 0.01 [ 95 % CI , -0.13 to 0.15 ] ) , but differed at day 7 favoring amoxicillin ( mean difference between groups of 0.19 [ 95 % CI , 0.024 to 0.35 ] ) . There was no statistically significant difference in reported symptom improvement at day 3 ( 37 % for amoxicillin group vs 34 % for control group ; P = .67 ) or at day 10 ( 78 % vs 80 % , respectively ; P = .71 ) , whereas at day 7 more participants treated with amoxicillin reported symptom improvement ( 74 % vs 56 % , respectively ; P = .02 ) . No between-group differences were found for any other secondary outcomes . No serious adverse events occurred . CONCLUSION Among patients with acute rhinosinusitis , a 10-day course of amoxicillin compared with placebo did not reduce symptoms at day 3 of treatment . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00377403 The efficacy , tolerability and safety of azithromycin and co-amoxiclav in the treatment of non-severe acute maxillary/ethmoidal sinusitis  were compared in a r and omized , open clinical trial in 254 adult patients . The predominant pathogens were Streptococcus pneumoniae and Haemophilus influenzae ( 83 patients ) .  Azithromycin was administered orally to 165 patients at a single daily dose of 500 mg for 3 days , and co-amoxiclav ( 4:1 ) to 89 patients , at a dose of 500 mg three times daily for 10 days . The overall clinical response rates were 87.5 % for azithromycin and 83.7 % for co-amoxiclav at follow-up ( day 21–28 ) . Microbiological responses to both drugs were good , with only five patients in each group having a persistent infection after treatment . Both drugs were well tolerated and produced similar incidences of adverse events , which were mostly gastrointestinal .  Azithromycin was as effective , and as well tolerated as co-amoxiclav , and its shorter simpler dosing regime may offer advantages in compliance and cost Abstract Background : Acute community-acquired sinusitis is considered a bacterial complication of the common cold . Radiologic abnormalities in sinuses occur , however , in most patients with upper respiratory virus infections . Objective : Assessment of the occurrence , clinical profile , laboratory findings , and outcome of radiologically confirmed sinusitis was carried out as part of a common cold study in young adults . Methods : Clinical examinations and radiography of the paranasal sinuses were carried out on days 1 , 7 , and 21 in 197 patients with the common cold . The symptoms were recorded on diary cards on days 1 to 20 . Ten viruses and 5 bacteria were studied as etiologic agents of common cold as reported earlier . Serum C reactive protein concentrations , erythrocyte sedimentation rates , and total white blood cell counts with differentials were determined in 40 r and omized subjects on day 7 . The effect of 6 days of intranasal fluticasone propionate treatment of the common cold in the prevention of sinusitis was analyzed . Results : On day 7 , 39 % of patients with the common cold in the placebo group ( n = 98 ) had sinusitis , which we would prefer to call viral sinusitis . The symptoms of patients with sinusitis and those without it were not clinical ly distinguishable . Viral infection was detected in 81.6 % of patients with sinusitis . No significantly increased levels of antibodies to bacteria were detected . Serum C reactive protein concentrations , erythrocyte sedimentation rates , and white blood cell counts were low in patients with sinusitis . All patients made a clinical recovery within 21 days without antibiotic treatment . Fluticasone propionate treatment tended to prevent par 
    Output:
    
However , amoxicillin-clavulanate had significantly more drop-outs due to adverse effects than cephalosporins and macrolides .
AUTHORS ' CONCLUSIONS There is moderate evidence that antibiotics provide a small benefit for clinical outcomes in immunocompetent primary care patients with uncomplicated acute sinusitis .