***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 r and omized , placebo-controlled , physician-blinded Canadian cooperative trial of cyclophosphamide and plasma exchange , neither active treatment regimens ( group I : IV cyclophosphamide and prednisone ; group II : weekly plasma exchange , oral cyclophosphamide , and prednisone ) were superior to placebo ( group III : sham plasma exchange and placebo medications ) using the blinded , evaluating neurologists ' assessment s of disease course ( primary analysis ) . All patients were examined by both a blinded and an unblinded neurologist at each assessment in this trial . We compared the blinded and unblinded neurologists ' judgment of treatment response and analyzed the clinical behavior of patients who correctly guessed their treatment . The unblinded ( but not the blinded ) neurologists ' scores demonstrated an apparent treatment benefit at 6 , 12 , and 24 months for the group II patients ( not group I or placebo ; p < 0.05 , two-tailed ) . There were no significant differences in the time to treatment failure or in the proportions of patients improved , stable , or worse between the group II and group III patients who correctly guessed their treatment assignments and those who did not . Physician blinding prevented an erroneous conclusion about treatment efficacy ( false positive , type 1 error ) Post-tonsillectomy bacteremia is a well-recognized aetiological factor in streptococcal endocarditis , and prophylactic penicillin has been recommended to reduce its incidence in susceptible patients undergoing tonsillectomy . Recent studies have shown a change in the microflora and an increase in the number of penicillin-resistant organisms in the tonsils of patients undergoing tonsillectomy . The aim of this study was to assess the incidence of post-tonsillectomy bacteraemia  , to identify the micro-organisms associated with it and to review the suitability of penicillin in prophylactic regimens . The relationship between positive blood cultures and several clinical parameters such as fever , vomiting , pharyngeal discomfort , or dysphagia was also analysed . Of the 102 patients included in the study , 41 ( 40.1 % ) had positive post-tonsillectomy blood cultures . Haemophilus influenzae were isolated from 23 ( 56 % ) of the positive cultures and Streptococcus viridans in 15 ( 36.5 % ) . Twenty-five per cent of H. influenzae produced beta-lactamase and only 30 % of streptococci of the viridans group were penicillin-sensitive . Positivity of the blood cultures was not related to fever , discomfort , surgical technique , type of tonsil , or any of the parameters studied . Bacteraemia seems to be related to traction of the tonsil before dissection rather than direct spread of bacteria into the opened vessels . Using a beta-lactamase stable antibiotic instead of penicillin for prophylaxis would be more appropriate OBJECTIVE Systemic antibiotics given during the first week after tonsillectomy appear to be effective in reducing postoperative morbidity . We assessed the effectiveness of perioperative topical antibiotic rinses in reducing posttonsillectomy morbidity . METHODS A r and omized , double-blinded , placebo-controlled pilot study of 36 patients undergoing tonsillectomy was used to evaluate the effects of a st and ard 7-day systemic regimen of perioperative intravenous ampicillin/oral amoxicillin and 2 single-day topical antibiotic regimens : ( 1 ) clindamycin ( Cleocin ) and ( 2 ) amoxicillin/clavulanate ( Augmentin ) and ticarcillin/clavulanate ( Timentin ) . RESULTS Mean aerobic and anaerobic oral bacterial counts were decreased in both topical treatment groups compared with the placebo group on the first postoperative day , achieving statistical significance with Augmentin/Timentin ( aerobic and anaerobic bacterial counts ) and Cleocin ( aerobic counts ) . Significantly less postoperative pain and mouth odor were reported for both Cleocin ( P = 0.014 and P = 0.005 , respectively ) and Augmentin/Timentin ( P = 0.026 and P = 0.05 , respectively ) topical treatment groups when compared with the placebo group . CONCLUSIONS Preliminary results indicate a reduction in oral bacterial counts and postoperative morbidity in adult patients receiving topical antibiotics  compared with patients receiving placebo ; further investigation is warranted Pain and secondary haemorrhage are the commonest complications of adult tonsillectomy , occurring mostly in the community . This is a r and omized , double-blind , placebo-controlled , prospect i ve trial of the effect of perioperative amoxycillin on these complications . The incidence and severity of post-operative haemorrhage was measured . For the first 10 post-operative days patients provided a linear pain score , a record of GP visits , and their use of additional antibiotics and analgesics . Of 95 patients considered : 23 suffered a secondary haemorrhage ; 54  consulted their general practitioner ( GP ) because of pain ; additional antibiotics were used by at least 31 and additional analgesics by at least 41 . No significant differences were demonstrated between the active and placebo groups for any of these measures . This study demonstrates that secondary haemorrhage is common after adult tonsillectomy .  Post-operative pain remains a major problem requiring frequent GP consultations . There appears to be no justification for the routine use of perioperative antibiotics OBJECTIVE To investigate the effect of fusafungine spray on pain and healing process after pediatric tonsillectomy . METHODS Sixty children with ages between 4 and 14 years underwent tonsillectomy or adenotonsillectomy .  The patients were r and omly divided into three groups and each group consisted of 20 patients . Group 1 was treated with antibiotic ( amoxicillin-clavulanic acid ) plus analgesic ( acetaminophen ) , group 2 was treated with fusafungine plus analgesic ( acetaminophen ) and group 3 was treated with only fusafungine .  The average ages were 7.8 + 3.4 , 6.6 + 2.9 , and 8.2 + 3.7 for groups 1 , 2 , and 3 , respectively . Clinical evaluations were made after the operation on the 1st ( T1 ) , 3rd ( T3 ) , 7th ( T7 ) , 10th ( T10 ) , and 14th days ( T14 ) . RESULTS There was no significant difference in post-operative pain between study groups on the post-operative 1st , 3rd , and 7th days ( P > 0.05 ) , a statistically significant difference was present between groups 1 and 3 , and groups 1 and 2 on the post-operative 10th and 14th day ( P = 0.018 and 0.037 , respectively ) . Pain was less in groups 2 and 3 than in group 1 on the 10th and 14th day . Also there was a significant difference in healing time of the tonsillary beds between groups 1 and 2 , and groups 1 and 3 on the 10th and 14th post-operative day ( P = 0.031 and 0.001 , respectively ) . Healing was better in groups 2 and 3 than in group 1 on the 10th and 14th day . CONCLUSION Fusafungine administration after tonsillectomy was found to be beneficial on post-operative pain and wound healing of tonsillary beds in pediatric population Tonsillectomy has been performed by a number of techniques . This double blind r and omized controlled study compares the technique of tissue coblation with bipolar dissection for the removal of tonsils in 10 adult patients with a history of chronic tonsillitis . A significant reduction in post-operative pain and more rapid healing of the tonsillar fossae were found in the side removed by tissue coblation . There were no episodes of primary or secondary haemorrhage on either side . This new technique for tonsil removal warrants further study OBJECTIVE To determine the current practice s of preoperative evaluation , surgical techniques , and postoperative treatment of pediatric adenotonsillectomy . STUDY DESIGN Forty-one-item survey measuring the frequency of different evaluations , procedures , and treatments performed , including selected case scenarios , with all items scored on a five-point ordinal scale ranking frequency . METHODS The entire membership of the American Society of Pediatric Otolaryngology ( ASPO ) and active fellows and members of the American Academy of Otolaryngology-Head and Neck Surgery ( AAO-HNS ) residing in New York state were anonymously surveyed through mail-in question naires . RESULTS History alone was the most frequent modality for diagnosing both adenoid enlargement and obstructive sleep apnea . The most common preoperative laboratory test ordered before an adenotonsillectomy is a complete blood cell count ; ASPO members ordered fewer preoperative laboratory tests than AAO-HNS members . Unipolar cautery is the most frequently used tonsillectomy technique , and curettage followed by cautery is the most popular adenoidectomy technique . Steroids are the most common intraoperative medication administered during an adenotonsillectomy , and office visits remain the most frequently used methods of assessing adenotonsillectomy patients postoperatively . CONCLUSIONS Although there are statistically significant trends uncovered by the survey , the results reflect a lack of consensus regarding adenotonsillectomy management . Further r and omized controlled trials or large-scale outcomes projects are much needed to evaluate critically the current practice s of pediatric adenotonsillectomies . Additional efforts may also be required to use the information from these studies in effecting changes in actual practice patterns , moving us toward a more evidence -based paradigm of treating pediatric adenotonsillar disease A prospect i ve study of 99 adults undergoing tonsillectomy  was carried out to determine the pattern of post-operative pain , intake of medication and timing of return to work and normal swallowing . The differences in the pain scores , as measured by a visual analogue scale , between every third consecutive day following post-operative day four were found to be highly significant ( p < 0.001 ) . Sixty-six patients ( 66.6 per cent ) required medication in the form of analgesics and /or antibiotics after the first post-operative day . Sixty-four out of a total of 82 patients ( 78.2 per cent ) returned to work within 14 days of surgery . Ninety-six patients ( 97 per cent ) reported normal swallowing within 14 days of surgery . These results suggest that the majority of adult patients undergoing tonsillectomy  can be appropriately advised pre-operatively regarding the probable pattern and duration of post-operative pain and the timescales they can expect to return to work and normal swallowing OBJECTIVES Tonsillectomy is one of the most commonly performed otolaryngologic procedures in the United States . Many options and controversies exist regarding techniques and peri-operative management . The purpose of the study was to examine current practice patterns among otolaryngologists regarding  tonsillectomy .  METHODS A 13 question survey regarding tonsillectomy techniques and peri-operative management was mailed to 10 % of r and omly selected board certified otolaryngologists of the AAO-HNS in the spring of 2002 . Four hundred and eighteen anonymously completed question naires were returned , for a response rate of 58.5 % . Statistical analysis of survey data was performed by means of cross tabulation and Pearson Chi-Square Calculation . RESULTS Monopolar electrocautery was the most common technique used among those surveyed ( 53.5 % ) . There was a significant correlation between choice of monopolar electrocautery and the cited reason for choice of technique being decreased blood loss ( P < 0.001 ) . There was no relationship between pediatric fellowship training and choice of technique . 97.7 % routinely admitted  sleep apnea patients  for post-operative observation . There was no significant correlation between practice setting ( tertiary versus community ) and type of post-operative monitoring for sleep apnea patients , with patients most commonly admitted to an intermediate care setting . CONCLUSION In our survey , the most common surgical technique for tonsillectomy was monopolar electrocautery , chosen for the reason of decreased blood loss Tonsillectomy continues to be a commonly performed operation in the pediatric age group . The postoperative period is often protracted and characterized by throat and ear pain , intermittent fever , foul odor from the oral cavity , and poor oral intake . Consequently , antibiotics are frequently prescribed in an effort to minimize these symptoms and /or avoid complications such as dehydration or secondary infection of the operative site . However , to our knowledge , no study to date has been performed to demonstrate the efficacy of antibiotic therapy in this setting . At the Children 's Hospital of Philadelphia , a prospect i ve , r and omized , double-blind study was undertaken in which ampicillin ( or placebo ) was administered intravenously at the time of surgery and for 12 to 24 hours postoperatively . The children then continued to receive oral amoxicillin therapy ( or placebo ) for an additional seven days . The patients were then evaluated for the incidence and severity of postoperative symptoms and complications . Intraoperative cultures of the oropharynx and tonsillar tissue , as well as cultures of the tonsillar fossa , were obtained following completion of one week of therapy . Our results indicate that ampicillin sodium/amoxicillin trihydrate therapy is well tolerated and safe in the nonallergic child and is effective in minimizing fever and other troublesome postoperative symptoms , such as pain , lassitude , mouth odor , and poor oral intake after tons 
    Output:
    
Most did not find a significant reduction in pain with antibiotics .
Similarly , antibiotics were mostly not shown to be effective in reducing the need for analgesics .
The present systematic review , including meta-analyses for select outcomes , suggests that although individual studies vary in their findings , there is no evidence to support a consistent , clinical ly important impact of antibiotics in reducing the main morbid outcomes following tonsillectomy ( i.e. pain , need for analgesia and secondary haemorrhage rates ) .