***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 compare the efficacy and safety of azithromycin with ofloxacin in patients with uncomplicated typhoid fever . MATERIAL AND METHODS Forty adult patients with bacteriologically or serologically diagnosed , uncomplicated typhoid fever were included from Medicine out-patient department at Government medical college , Amritsar , India . They were r and omized into 2 groups of 20 patients each . Group I : patients received ofloxacin 200 mg orally twice daily for 7 days . Group II : Patients received Azithromycin orally 1 gm on day 1 and then 500 mg daily from day 2 to day 6 . The following parameters were noted a ) fever clearance time b ) cure rate c ) adverse drug reaction d ) recurrence of symptoms , if any , during 4 weeks follow up . RESULTS Nineteen out of 20 patients from group I were cured with mean fever clearance time of 3.68 days while all 20 patients from group II were cured with mean fever clearance time of 3.65 days . No significant side effects were noted in any of the patients . No relapse was recorded in the present study in a follow up period of 4 weeks in both study groups . CONCLUSION Both ofloxacin and Azithromycin are almost equally efficacious and safe in treatment of typhoid fever with no major adverse effect . Azithromycin is an effective alternative in conditions where ofloxacin is contraindicated i.e. , children , pregnant women and quinolone resistant cases of typhoid fever Although long-term azithromycin decreases exacerbation frequency in bronchiectasis , increased macrolide resistance is concerning . We investigated macrolide resistance determinants in a secondary analysis of a multicenter r and omized controlled trial . Indigenous Australian children living in remote regions and urban New Zeal and Māori and Pacific Isl and er children with bronchiectasis were r and omized to weekly azithromycin ( 30 mg/kg ) or placebo for up to 24 months and followed post-intervention for up to 12 months . Nurses administered and recorded medications given and collected nasopharyngeal swabs 3–6 monthly for culture and antimicrobial susceptibility testing . Nasopharyngeal carriage of Haemophilus influenzae and Moraxella catarrhalis was significantly lower in azithromycin compared to placebo groups , while macrolide-resistant Streptococcus pneumoniae and Staphylococcus aureus carriage was significantly higher . Australian children , compared to New Zeal and children , had higher carriage overall , significantly higher carriage of macrolide-resistant bacteria at baseline ( 16/38 versus 2/40 children ) and during the intervention ( 69/152 versus 22/239 swabs ) , and lower mean adherence to study medication ( 63 % versus 92 % ) . Adherence ≥70 % ( versus < 70 % ) in the Australian azithromycin group was associated with lower carriage of any pathogen [ odds ratio ( OR ) 0.19 , 95 % confidence interval ( CI ) 0.07–0.53 ] and fewer macrolide-resistant pathogens ( OR 0.34 , 95 % CI 0.14–0.81 ) . Post-intervention ( median 6 months ) , macrolide resistance in S. pneumoniae declined significantly in the azithromycin group , from 79 % ( 11/14 ) to 7 % ( 1/14 ) of positive swabs , but S. aureus strains remained 100 % macrolide resistant . Azithromycin treatment , the Australian remote setting , and adherence < 70 % were significant independent determinants of macrolide resistance in children with bronchiectasis . Adherence to treatment may limit macrolide resistance by suppressing carriage Background Patients with severe asthma are at increased risk of exacerbations and lower respiratory tract infections ( LRTI ) . Severe asthma is heterogeneous , encompassing eosinophilic and non-eosinophilic ( mainly neutrophilic ) phenotypes . Patients with neutropilic airway diseases may benefit from macrolides . Methods We performed a r and omised double-blind placebo-controlled trial in subjects with exacerbation-prone severe asthma . Subjects received low-dose azithromycin ( n=55 ) or placebo ( n=54 ) as add-on treatment to combination therapy of inhaled corticosteroids and long-acting β2 agonists for 6 months . The primary outcome was the rate of severe exacerbations and LRTI requiring treatment with antibiotics during the 26-week treatment phase . Secondary efficacy outcomes included lung function and scores on the Asthma Control Question naire ( ACQ ) and Asthma Quality of Life Question naire ( AQLQ ) . Results The rate of primary endpoints ( PEPs ) during 6 months was not significantly different between the two treatment groups : 0.75 PEPs ( 95 % CI 0.55 to 1.01 ) per subject in the azithromycin group versus 0.81 PEPs ( 95 % CI 0.61 to 1.09 ) in the placebo group ( p=0.682 ) . In a predefined subgroup analysis according to the inflammatory phenotype , azithromycin was associated with a significantly lower PEP rate  than placebo in subjects with non-eosinophilic severe asthma ( blood eosinophilia ≤200/µl ) : 0.44 PEPs ( 95 % CI 0.25 to 0.78 ) versus 1.03 PEPs ( 95 % CI 0.72 to 1.48 ) ( p=0.013 ) . Azithromycin  significantly improved the AQLQ score but there were no significant between-group differences in the ACQ score or lung function . Azithromycin was well tolerated , but was associated with increased oropharyngeal carriage of macrolide-resistant streptococci . Conclusions Azithromycin did not reduce the rate of severe exacerbations and LRTI in patients with severe asthma . However , the significant reduction in the PEP rate in azithromycin-treated patients with non-eosinophilic severe asthma warrants further study . Clinical Trials.gov number NCT00760838 Treatment of osteitis after surgical removal of the third molar of the m and ible is still a clinical problem . A total of 140 patients undergoing operations for removal of an impacted third molar of the m and ible , were included in a double-blind study . Placebo or antibiotics - azidocillin , erythromycin , clindamycin and doxycycline - were given to the patients preoperatively and for the following 7 days . The concentrations in serum , alveolar serum and m and ibular bone were measured and the postoperative courses - pain , trismus , swelling and wound-healing - were recorded . No correlation was obtained between the antibiotic concentration and the postoperative complaints , except in the azidocillin group on day 2 , in which fewer complaints were noticed in patients with high concentrations of the drug at the time of operations . The 80 patients in the antibiotic groups responded significantly better with respect to wound-healing than the 60 patients in the placebo groups . Only 15 operations lasted more than 15 min and the three of them which subsequently result ed in alveolitis were in the placebo groups . Antibiotics significantly reduced pain on day 7 postoperatively . In general , no statistically significant differences in trismus and swelling could be demonstrated between the patient groups . However , there was a significant difference between the placebo and doxycycline groups with respect to swelling ( day 2 postoperative , P < 0.01 ; day 5 postoperative , P < 0.05 ) . Thus systemically administered antibiotics offered only slight advantages in routine operations of impacted third m and ibular molars , but could decrease the rate of infections after traumatic operations OBJECTIVE To determine the efficacy of clarithromycin in the treatment of Pityriasis Rosea ( PR ) . STUDY DESIGN Double blind r and omized controlled trial . PLACE AND DURATION OF STUDY Dermatology OPD , Military Hospital , Rawalpindi , from July 2008 to July 2009 . METHODOLOGY Patients aged above 10 years , diagnosed with PR , were r and omly assigned to two groups of 30 each to receive either clarithromycin or similar-looking placebo for one week . Neither the patient nor the treating physician knew to which group the patient belonged . Patients were assessed at 1 , 2 , 4 and 6 weeks after presentation and compared for complete , partial or no response . RESULTS Among the 60 patients , no significant difference was found between the two groups at 2 weeks after presentation ( p = 0.598 ) . In the placebo group , complete response was seen in 20 ( 66.7 % ) , partial response in 3 ( 10.0 % ) while no response was seen in 7 ( 23.3 % ) . In clarithromycin group , there was complete response in 23 ( 76.7 % ) , partial response in 3 ( 10.0 % ) and no response in 4 ( 13.3 % ) patients . CONCLUSION Clarithromycin is not effective in treatment of pityriasis rosea Serial quantitative nasal cultures were performed on 87 healthy nasal carriers of Staphylococcus aureus , who were r and omly assigned to 7 days of oral therapy with erythromycin , rosamicin ( an investigational macrolide antibiotic ) , or placebo .  Staphylococcal carrier rates decreased during therapy with both antibiotics ; however , erythromycin was significantly more effective in lowering carrier rates than was rosamicin . The anti-staphylococcal effects of both antibiotics were similar when the mean numbers of S. aureus isolated from positive cultures during therapy were compared . Side effects to each regimen were minimal New drugs are needed for preventing drug-resistant Plasmodium falciparum malaria . The prophylactic efficacy of azithromycin against P. falciparum in malaria-immune Kenyans was 83 % . We conducted a double-blind , placebo-controlled trial to determine the prophylactic efficacy of azithromycin against multidrug-resistant P. falciparum malaria and chloroquine-resistant Plasmodium vivax malaria in Indonesian adults with limited immunity . After radical cure therapy , 300 r and omized subjects received azithromycin ( 148 subjects , 750-mg loading dose followed by 250 mg/d ) , placebo ( 77 ) , or doxycycline ( 75 , 100 mg/d ) . The end point was slide-proven parasitemia . There were 58 P. falciparum and 29 P. vivax prophylaxis failures over 20 weeks . Using incidence rates , the protective efficacy of azithromycin relative to placebo was 71.6 % ( 95 % confidence interval [ CI ] , 50.3 - 83.8 ) against P. falciparum malaria and 98.9 % ( 95 % CI , 93.1 - 99.9 ) against P. vivax malaria . Corresponding figures for doxycycline were 96.3 % ( 95 % CI , 85.4 - 99.6 ) and 98 % ( 95 % CI , 88.0 - 99.9 ) , respectively . Daily azithromycin offered excellent protection against P. vivax malaria but modest protection against P. falciparum malaria Summary Because of the significant morbidity and mortality associated with opportunistic infections , prophylaxis has become routine practice in the management of immunocompromised patients such as those with AIDS .  Clarithromycin , an antimicrobial agent with a broad spectrum of activity against most common respiratory pathogens as well as many protozoa , has proven to be effective for both treatment and prophylaxis of Mycobacterium avium-intracellulare complex ( MAC ) infection in AIDS patients . Results of a large multinational placebo-controlled study suggest that clarithromycin for MAC prophylaxis provides additional benefits . In this study , clarithromycin statistically significantly reduced the incidence of Pneumocystis carinii pneumonia ( 5.3 % of clarithromycin recipients vs 10.0 % of placebo recipients ; p=0.021 ) , community-acquired pneumonia ( 7.1 vs 13.0 % ; p=0.010 ) , Giardia lamblia infection ( 0.9 vs 2.9 % ; p=0.048 ) , and neoplastic diseases ( 1.8 vs 4.1 % ; p=0.010 ) in AIDS patients with CD4 + counts of ≤ 100 cells/μl Background We conducted a placebo-controlled trial of azithromycin therapy in bronchiolitis obliterans syndrome ( BOS ) post lung transplantation . Methods We compared azithromycin ( 250 mg alternate days , 12 weeks ) with placebo . Primary outcome was FEV1 change at 12 weeks . Results 48 patients were r and omised ; ( 25 azithromycin , 23 placebo ) . It was established , post r and omisation that two did not have BOS . 46 patients were analysed as intention to treat ( ITT ) with 33 ‘ Completers ’ . ITT analysis included placebo patients treated with open-label azithromycin after study withdrawal . Outcome The ITT analysis ( n=46 , 177 observations ) estimated mean difference in FEV1 between treatments 
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Most trials were conducted in secondary care setting s. Azithromycin and erythromycin were more commonly studied than clarithromycin and roxithromycin .
There was no clear consistent difference in gastrointestinal adverse events between different types of macrolides or route of administration .
We did not find any evidence that appetite loss , dizziness , headache , respiratory symptoms , blood infections , skin and soft tissue infections , itching , or rashes were reported more often by participants treated with macrolides compared to placebo .
Macrolides caused less cough ( OR 0.57 , 95 % CI 0.40 to 0.80 ; moderate- quality evidence ) and fewer respiratory tract infections ( OR 0.70 , 95 % CI 0.62 to 0.80 ; moderate- quality evidence ) compared to placebo , probably because these are not adverse events , but rather characteristics of the indications for the antibiotics .
Macrolide-resistant bacteria were more commonly identified among participants immediately after exposure to the antibiotic .
The macrolides as a group clearly increased rates of gastrointestinal adverse events .
This was especially true for the adverse event of bacterial resistance