***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 
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    ***EXAMPLES*** 
    Input: We started therapy sinusitis of our patients with antibiotics cefuroxime axetil ( Zinnat , GSK ) , clarithromycin ( Klacid Uno , Abbott ) and  orally given steroid-prednisone in one group ( A+S ) 56 patients . Second group of 60 patients were cured only with antibiotics ( A ) . We compare effects of this therapy . There were 50 % totally cured patients in the first group ( A+S ) and 46.6 % cured in the second group . Percentage totally cured patients with ( A+S ) is 3.4 % better that cured only with antibiotics in the same time . It is statistically important . We present benefits for patients who were operated in the next step . Post therapy with the use of antibiotics and steroids there were less bleeding from the mucosal membrane , and there was no edema . It is a good method of therapy if patients have no contraindications BACKGROUND The place of systemic corticosteroids in the treatment of children with chronic rhinosinusitis ( CRS ) remains unclear . OBJECTIVE We sought to assess the effectiveness and tolerability of oral methylprednisolone as an anti-inflammatory adjunct in the treatment of CRS in children . METHODS Forty-eight children ( age , 6 - 17 years ) with clinical ly and radiologically proved CRS were included . Patients were r and omly assigned to either oral amoxicillin/clavulanate ( AMX/C ) and methylprednisolone or AMX/C and placebo twice daily for 30 days . Oral methylprednisolone was administered for the first 15 days with a tapering schedule . Primary parameters were mean change in symptom and sinus computed tomographic ( CT ) scan scores after treatment . Secondary study parameters were mean changes in individual symptom scores after treatment , relapse rate , and tolerability . RESULTS Forty-five patients completed the study : 22 received AMX/C and methylprednisolone , and 23 received AMX/C and placebo . Both groups demonstrated significant improvements in symptom and sinus CT scores when comparing baseline values with end-of-treatment values ( P < .001 ) . Methylprednisolone as an adjunct was significantly more effective than placebo in reducing CT scores ( P = .004 ) , total rhinosinusitis symptoms ( P = .001 ) , and individual symptoms of nasal obstruction ( P = .001 ) , postnasal discharge ( P = .007 ) , and cough ( P = .009 ) . At the end of treatment , 48 % of the children in the placebo group still had abnormal findings on CT scans versus 14 % in the methylprednisolone group ( P = .013 ) . Therapy-related adverse events were not different between groups . Although insignificant , the incidence of clinical relapses was also less in the methylprednisolone group ( 25 % ) compared with that in the placebo group ( 43 % , P = .137 ) . CONCLUSION Oral methylprednisolone is well tolerated and provides added benefit to treatment with antibiotics for children with CRS Background : Patients with acute rhinosinusitis are frequently encountered in primary care . Although corticosteroids are being increasingly used for symptom control , evidence supporting their use is inconclusive . We conducted a r and omized controlled trial to examine the effectiveness of systemic corticosteroid monotherapy for clinical ly diagnosed , uncomplicated acute rhinosinusitis . Methods : We conducted a block-r and omized , double-blind , placebo-controlled clinical trial at 54 primary care practice s ( 68 family physicians ) in the Netherl and s between Dec. 30 , 2008 , and Apr. 28 , 2011 . Adult patients with clinical ly diagnosed acute rhinosinusitis were r and omly assigned to receive either prednisolone 30 mg/d or placebo for 7 days and asked to complete a symptom diary for 14 days . The primary outcome measure was the proportion of patients with resolution of facial pain or pressure on day 7 . Results : Of the 185 patients included in the trial ( 93 in the treatment group , 92 in the placebo group ) , 2 withdrew from the study and 9 were excluded from the primary analysis because of incomplete symptom reporting . The remaining 174 patients ( 88 in the treatment group , 86 in the placebo group ) were included in the intention-to-treat analysis . The proportions of patients with resolution of facial pain or pressure on day 7 were 62.5 % ( 55/88 ) in the prednisolone group and 55.8 % ( 48/86 ) in the placebo group ( absolute risk difference 6.7 % , 95 % confidence interval −7.9 % to 21.2 % ) . The groups were similar with regard to the decrease over time in the proportion of patients with total symptoms ( combined symptoms of runny nose , postnasal discharge , nasal congestion , cough and facial pain ) and health-related quality of life . Adverse events were mild and did not differ significantly between the groups . Interpretation : Systemic corticosteroid monotherapy had no clinical ly relevant beneficial effects among patients with clinical ly diagnosed acute rhinosinusitis . Netherl and s Trial Register registration no. 1295 ( www.trialregister.nl/trialreg/index.asp ) CONTEXT Acute sinusitis is a common clinical problem that usually results in a prescription for antibiotics but the role of antibiotics is debated . Anti-inflammatory drugs such as topical steroids may be beneficial but are under research ed . OBJECTIVE To determine the effectiveness of amoxicillin and topical budesonide in acute maxillary sinusitis .  DESIGN , SETTING , AND PATIENTS A double-blind , r and omized , placebo-controlled factorial trial of 240 adults ( aged > or = 16 years ) with acute nonrecurrent sinusitis ( had > or = 2 diagnostic criteria : purulent rhinorrhea with unilateral predominance , local pain with unilateral predominance , purulent rhinorrhea bilateral , presence of pus in the nasal cavity ) at 58 family practice s ( 74 family physicians ) between November 2001 and November 2005 . Patients were r and omized to 1 of 4 treatment groups : antibiotic and nasal steroid ; placebo antibiotic and nasal steroid ; antibiotic and placebo nasal steroid ; placebo antibiotic and placebo nasal steroid . INTERVENTION A dose of 500 mg of amoxicillin 3 times per day for 7 days and 200 mug of budesonide in each nostril once per day for 10 days . MAIN OUTCOME MEASURES Proportion clinical ly cured at day 10 using patient symptom diaries and the duration and severity of symptoms . RESULTS The proportions of patients with symptoms lasting 10 or more days were 29 of 100 ( 29 % ) for amoxicillin vs 36 of 107 ( 33.6 % ) for no amoxicillin ( adjusted odds ratio , 0.99 ; 95 % confidence interval , 0.57 - 1.73 ) . The proportions of patients with symptoms lasting 10 or more days were 32 of 102 ( 31.4 % ) for topical budesonide vs 33 of 105 ( 31.4 % ) for no budesonide ( adjusted odds ratio , 0.93 ; 95 % confidence interval , 0.54 - 1.62 ) . Secondary analysis suggested that nasal steroids were significantly more effective in patients with less severe symptoms at baseline . CONCLUSION Neither an antibiotic nor a topical steroid alone or in combination was effective as a treatment for acute sinusitis in the primary care setting . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N60825437 Abstract Objective : To evaluate the diagnostic value of symptoms , signs , erythrocyte sedimentation rate , and C reactive protein for acute maxillary sinusitis . Design : Prospect i ve cohort study . Setting : Danish general practice in cooperation with the otorhinolaryngology and neuroradiology department at Aalborg County Hospital . Subjects : 174 patients aged 18 - 65 years who were suspected by the general practitioner of having acute maxillary sinusitis . > Main outcome measure : The independent association of symptoms , signs , erythrocyte sedimentation rate , and concentration of C reactive protein in patients with acute maxillary sinusitis defined as purulent or mucopurulent antral aspirate . Results : Only raised erythrocyte sedimentation rate ( P=0.01 ) and raised C reactive protein ( P=0.007 ) were found to be independently associated with a diagnosis of acute maxillary sinusitis . The combination of the two variables had a sensitivity of 0.82 and a specificity of 0.57 . Conclusion : Erythrocyte sedimentation rate and C reactive protein are useful diagnostic criteria for acute maxillary sinusitis BACKGROUND Chronic rhinosinusitis ( CRS ) with nasal polyposis is common . The long-term efficacy and safety of approaches to medical management are not well-known . OBJECTIVE To evaluate the efficacy and safety of a 2-week regimen of oral steroid therapy followed by 26 weeks of sequential topical steroid maintenance therapy . DESIGN Parallel r and omized trial with computer-generated block r and omization and central allocation . Patients and investigators were blinded to group assignment . ( Clinical Trials.gov registration number : NCT00788749 ) SETTING A specialty rhinology clinic in Tayside , Scotl and . PATIENTS 60 adults with CRS and moderate-sized or larger nasal polyps who were referred by their primary physicians for specialty care . INTERVENTIONS Patients were r and omly assigned in a 1:1 ratio to receive oral prednisolone , 25 mg/d , or placebo for 2 weeks , followed in both groups by fluticasone propionate nasal drops , 400 µg twice daily , for 8 weeks and then fluticasone propionate nasal spray , 200 µg twice daily , for 18 weeks . MEASUREMENTS Polyp grading ( primary outcome ) , hyposmia score , quality of life , symptoms , nasal patency , adrenal function , and bone turnover . RESULTS The mean decrease in polyp grade from baseline to 2 weeks was 2.1 units ( SD , 1.1 ) in the prednisolone group and 0.1 unit ( SD , 1.0 ) in the placebo group ( mean difference between groups , -1.8 units [ 95 % CI , -2.4 to -1.2 units ] ; P < 0.001 ) . The difference between groups was -1.08 units ( CI , -1.74 to -0.42 unit ; P = 0.001 ) at 10 weeks and -0.8 unit ( CI , -1.8 to 0.2 unit ; P = 0.11 ) at 28 weeks . The mean decrease in hyposmia score from baseline to 2 weeks was 31.12 mm ( SD , 30.1 ) in the prednisolone group and 1.41 mm ( SD , 30.6 ) in the placebo group ( mean difference between groups , -28.33 mm [ CI , -42.71 to -13.96 mm ] ; P = 0.002 ) . The difference between groups was -16.06 mm ( CI , -30.99 to -1.13 mm ; P = 0.03 ) at 10 weeks and -12.13 mm ( CI , -30.55 to 6.29 mm ; P = 0.19 ) at 28 weeks . Prednisolone therapy result ed in transient suppression of adrenal function and increase in bone turnover after 2 weeks , with a return to baseline at 10 and 28 weeks . LIMITATIONS Patients were referred from primary care to a single-center rhinology clinic , which limits the generalizability of results . Serial measurements of surrogates of nasal inflammation ( such as nitric oxide or cytokine levels ) were not performed . CONCLUSION Initial oral steroid therapy followed by topical steroid therapy seems to be more effective over 6 months than topical steroid therapy alone in decreasing polyp size and improving olfaction in patients referred for specialty care of CRS with at least moderate nasal polyposis . PRIMARY FUNDING SOURCE Chief Scientist Office , Scotl and ; National Health Service Tayside Small Grants Scheme ; and an Anonymous Trust grant from University of Dundee OBJECTIVE Acute maxillary rhinosinusitis ( AMRS ) is a pathology in which the pain is often severe and requires appropriate treatment . Although the use of antibiotics is widely documented , the interest of short cycles of corticosteroids in the treatment of the functional manifestations of AMRS is based on professional experience . The aim of this study was to assess the efficacy and tolerance to prednisone administered for 3 days in addition to antibiotherapy in patients presenting with an AMRS . METHOD This was a double blind , r and omised study in parallel groups and controlled versus a placebo , involving patients aged over 18 , presenting with an AMRS confirmed by X-ray and endoscopy , having developed less than 5 days and complaining of spontaneous pain assessed as > or=50 millimetres on a visual analog scale ( VAS ) . Together with cefpodoxime , the patients received either prednisone ( 0.8 to 1.2 mg/kg ) for 3 days 
    Output:
    
Reported side effects in patients treated with oral corticosteroids were mild ( nausea , vomiting , gastric complaints ) and did not significantly differ from those receiving placebo .
AUTHORS ' CONCLUSIONS Oral corticosteroids as a monotherapy appear to be ineffective for adult patients with clinical ly diagnosed acute sinusitis .
This limited evidence suggests that oral corticosteroids in combination with antibiotics may be modestly beneficial for short-term relief of symptoms in acute sinusitis , with a number needed to treat to benefit of seven for resolution or symptom improvement .