***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 establish whether an interactive booklet on  respiratory tract infections in children reduces reconsultation for the same illness episode , reduces antibiotic use , and affects future consulting intentions , while maintaining parental satisfaction with care . Design Pragmatic cluster r and omised controlled trial . Setting 61 general practice s in Wales and Engl and . Participants 558 children ( 6 months to 14 years ) presenting to primary care with an acute respiratory tract infection ( 7 days or less ) . Children with suspected pneumonia , asthma or a serious concomitant illness , or needing immediate hospital admission were excluded . Three withdrew and 27 were lost to follow-up , leaving 528 ( 94.6 % ) with main outcome data . Interventions Clinicians in the intervention group were trained in the use of an interactive booklet on respiratory tract infections and asked to use the booklet during consultations with recruited patients ( and provide it as a take home re source ) . Clinicians in the control group conducted their consultations as usual . Main outcome measures The proportion of children who attended a face-to-face consultation about the same illness during the two week follow-up period . Secondary outcomes included antibiotic prescribing , antibiotic consumption , future consulting intentions , and parental satisfaction , reassurance , and enablement . Results Reconsultation occurred in 12.9 % of children in the intervention group and 16.2 % in the control group ( absolute risk reduction 3.3 % , 95 % confidence interval −2.7 % to 9.3 % , P=0.29 ) . Using multilevel modelling ( at the practice and individual level ) to account for clustering , no significant difference in reconsulting was noted ( odds ratio 0.75 ; 0.41 to 1.38 ) . Antibiotics were prescribed at the index consultation to 19.5 % of children in the intervention group and 40.8 % of children in the control group ( absolute risk reduction 21.3 % , 95 % confidence interval 13.7 to 28.9 ) , P<0.001 ) . A significant difference was still present after adjusting for clustering ( odds ratio 0.29 ; 0.14 to 0.60 ) . There was also a significant difference in the proportion of parents who said they would consult in the future if their child developed a similar illness ( odds ratio 0.34 ; 0.20 to 0.57 ) . Satisfaction , reassurance , and parental enablement scores were not significantly different between the two groups . Conclusions Use of a booklet on respiratory tract infections in children within primary care consultations led to important reductions in antibiotic prescribing and reduced intention to consult without reducing satisfaction with care . Trial registration Current Controlled Trials IS RCT BACKGROUND Overuse of antibiotics for children 's upper respiratory infections is widespread and contributes to the emergence of antibiotic-resistant bacteria . OBJECTIVE To assess changes in knowledge and awareness regarding antibiotic resistance and appropriate antibiotic use after community-wide educational interventions to reduce inappropriate antibiotic use . DESIGN Baseline survey conducted during June through July 1997 and postintervention survey of baseline participants during June through August 1998 . SETTING Communities in northern Wisconsin . PARTICIPANTS Parents of 729 r and omly selected children < 4 years of age were called until 215 in each of the intervention and control areas were reached . Of the 430 baseline participants , 365 ( 85 % ) participated in the postintervention survey . INTERVENTION Parent-oriented activities included distribution of material s and presentations . Physician-oriented activities included formal presentations and small group meetings . OUTCOME MEASURE Change in awareness about antibiotic resistance and knowledge about antibiotic indications . RESULTS A higher proportion of parents in the intervention area ( 53 % ) were exposed to 2 or more local educational messages , compared with the control area ( 23 % ) . From the baseline to the postintervention survey , the percentage of parents with a high degree of antibiotic resistance awareness increased more in the intervention area ( 58 % to 73 % ) than in the control area ( 60 % to 65 % ) . In the intervention area , there was also a larger increase in knowledge regarding appropriate indications for antibiotic use , compared with the control area . The proportion of parents who expected an antibiotic for their child and did not receive one declined in the intervention area ( 14 % to 9 % ) , while it increased in the control area ( 7 % to 10 % ) . In addition , the percentage of parents in the intervention area who brought their child to another physician because they did not receive an antibiotic decreased ( 5 % to 2 % ) , while it increased in the control area ( 2 % to 4 % ) . CONCLUSION Parental knowledge and awareness about antibiotic indications and antibiotic resistance can be changed with educational interventions directed at parents and clinicians BACKGROUND Public attitudes and expectations contribute to inappropriate antibiotic prescribing and antibiotic resistance . This study assessed knowledge , attitudes , and experiences regarding antibiotic use for respiratory infection or illness . METHODS R and om-digit-dialing telephone surveys of adults and parents of children < 5 years old were conducted in Wisconsin and Minnesota during 1999 . RESULTS The survey was completed by 405 adults and 275 parents of children < 5 years old . The median age was 32 years for parents and 50 years for adults . Seven percent of parents and 17 % of adults believed that antibiotics are never or almost never necessary for bronchitis . More than 70 % in each group believed that antibiotics are needed for green or yellow nasal drainage , and nearly half of respondents believed that they knew whether an antibiotic was needed before seeing a physician . Exposure to multiple information sources on antibiotic resistance in the past 6 months was independently associated with a knowledge score greater than or equal to the median for nine questions . CONCLUSIONS The general public has misconceptions regarding indications for antibiotic use , and this may contribute to inappropriate prescribing . Providing multiple and varied antibiotic-related informational messages may increase knowledge of appropriate antibiotic prescribing and decrease patient dem and for antibiotics BACKGROUND General practitioners ( GPs ) prescribe antibiotics to three-quarters of patients who consult with a lower respiratory tract illness ( LRTi ) . In spite of this management , around a quarter of patients reconsult for the same symptoms within a month . AIM To investigate the impact of providing a simple leaflet regarding the natural history of lower respiratory tract symptoms on reconsultation rates for previously well adults presenting to their GP with an LRTi . METHOD Seventy-six GPs studied 1014 previously well adults presenting with an illness defined as an LRTi . Management was left to the GP 's discretion . Half of the patients were r and omly allocated to receive an information leaflet at the end of the consultation , blinded from the GP . The endpoint was reconsultation for the same symptoms within one month . RESULTS Follow-up data was available for 1006 adults , of whom 182 ( 18 % ) reconsulted . Fewer patients who received the leaflet ( 75/505 ; 14.9 % ) returned to the surgery compared with those who did not ( 107/501 ; 21.4 % ; P = 0.007 ) . The same benefit was found for the 723 ( 72 % ) adults treated initially with antibiotics ; 16 % ( 60/369 ) in the leaflet group returned compared with 23 % ( 81/354 ) in the no leaflet group ( P = 0.02 ) . CONCLUSION Informing previously well patients about the natural history of LRTi symptoms is an effective strategy for reducing reconsultations , benefiting the patient and the GP ; it is likely to reduce antibiotic prescriptions and future patient consultation habits Abstract Objective : To assess whether sharing the uncertainty of the value of antibiotics for acute bronchitis in the form of written and verbal advice affects the likelihood of patients taking antibiotics .  Design : Nested , single blind , r and omised controlled trial . Setting : Three suburban general practice s in Nottingham . Participants : 259 previously well adults presenting with acute bronchitis . Intervention : In group A , 212 patients were judged by their general practitioner not to need antibiotics that day but were given a prescription to use if they got worse and st and ard verbal reassurance . Half of them ( 106 ) were also given an information leaflet . All patients in group B ( 47 ) were judged to need antibiotics and were given a prescription and encouraged to use it . Main outcome measures : Antibiotic use in the next two weeks . Reconsultation for the same symptoms in the next month . Results : In group A fewer patients who received the information leaflet  took antibiotics compared with those who did not receive the leaflet ( 49 v 63 , risk ratio 0.76 , 95 % confidence interval 0.59 to 0.97 , P=0.04 ) . Numbers reconsulting were similar ( 11 v 14 ) . In group B , 44 patients took the antibiotics . Conclusion : Most previously well adults with acute bronchitis were judged not to need antibiotics . Reassuring these patients and sharing the uncertainty about prescribing in a information leaflet supported by verbal advice is a safe strategy and reduces antibiotic use . What is already known on this topic Most adults with acute bronchitis who consult their general practitioner will receive antibiotics For most patients antibiotics do not modify the natural course of the symptoms The widespread belief among patients that infection is the problem and antibiotics the solution has considerable influence on prescribing by general practitioners , even when they judge that antibiotics are not definitely indicated What this study adds General practitioners judged that about four in five adults with acute bronchitis did not definitely need antibiotics on the day they consulted Antibiotic use was reduced by a quarter in such patients , who received verbal and written information and reassurance in addition to a prescription for antibiotics Sharing with the patient the uncertainty about the decision to prescribe seems safe and Objective To characterise the prescription of non-formulary drugs to children and neonates at a Brazilian teaching hospital and identify adverse drug reactions ( ADRs ) , drug interactions , and prescription of potentially hazardous medicines . Methods A prospect i ve exploratory study was carried out between January and May 2011 at the general paediatric wards and paediatric oncology , paediatric intensive care , and neonatal care units of the study hospital .  Non-formulary drugs were categorised as approved , off-label , or not approved for use in children according to Brazilian compendia . Electronic health records were actively search ed for ADRs and the possibility of moderate to severe interactions between non-formulary drugs and other medicines was determined with the Micromedex ® data base . Results Overall , 109 children or neonates received non-formulary drugs . Of these drugs , 54 % were approved for use in children , 12.2 % were used off-label , and 33.8 % were not approved for use in children . Non-formulary drugs accounted for 13.4 % of total prescriptions ; 5.3 % of drugs had a potential for interactions and five were possibly associated with ADRs . Conclusions Prescription of non-formulary drugs not approved for use in children was common at the study hospital . Studies such as this provide information on the use of medicines for special indications and permit assessment of the relevance of hospital formularies for the paediatric population Objectives To test the hypothesis that a multifaceted , local public campaign could be feasible and influence antibiotic prescribing for out patients . Design Community level , controlled , non-r and omised trial . Setting Provinces of Modena and Parma in Emilia-Romagna , northern Italy , November 2011 to February 2012 . Population 1 150 000 residents of Modena and Parma ( intervention group ) and 3 250 000 residents in provinces in the same region but where no campaign had been implemented ( control group ) . Interventions Campaign material s ( mainly posters , brochures , and advertisements on local media , plus a newsletter on local antibiotic resistance targeted at doctors and pharmacists ) . General practitioners and paediatricians in the intervention area participated in design ing the campaign messages . Main outcomes measures Primary outcome was the average change in prescribing rates of antibiotics for outpatient in five months , measured as defined daily doses per 1000 inhabitants/day , using health districts as the unit of analysis . Results Antibiotic prescribing was reduced in the intervention area compared with control area ( −4.3 % , 95 % confidence interval −7.1 % to −1.5 % ) . This result was robust to “ sensitivity analysis ” modifying the baseline period from two months ( main analysis ) to one month . A higher decrease was observed for penicillins resistant to β lactamase and a lower decrease for penicillins susceptible to β lactamase , consistent with the content of the newsletter on antibiotic resistance directed at health professionals . The decrease in expenditure on antibiotics was not statistically significant in a district level analysis with a two month baseline period ( main analysis ) , but was statistically significant in sensitivity analyses using either a one month baseline period or a more powered doctor level analysis . Knowledge and attitudes of the target population about the correct use of antibiotics did not differ between the intervention and control areas . Conclusions A local low cost information campaign targeted at citizens , combined with a newsletter on local antibiotic resistance targeted at doctors and pharmacists , was associated with significantly decreased total rates of antibiotic prescribing but did not affect the 
    Output:
    
Analysis showed that interventions targeting schoolchildren and parents have notable potential , but for the general public the picture is less clear .
Conclusions Our work provides an in-depth examination of the effectiveness of AMR interventions for the public .