***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: BACKGROUND The value of azithromycin for treatment of acute bronchitis is unknown , even though this drug is commonly prescribed . We have investigated this question in a r and omised , double-blind , controlled trial . METHODS Adults diagnosed with acute bronchitis , without evidence of underlying lung disease , were r and omly assigned  azithromycin ( n=112 ) or vitamin C  ( n=108 ) for 5 days ( total dose for each 1.5 g ) . All individuals were also given liquid dextromethorphan and albuterol inhaler with a spacer . The primary outcome was improvement in health-related quality of life at 7 days ; an important difference was defined as 0.5 or greater . Analysis was by intention to treat . FINDINGS The study was stopped by the data -monitoring and safety committee when 220 patients had been recruited . On day 7 , the adjusted difference in health-related quality of life was small and not significant ( difference 0.03 [ 95 % CI -0.20 to 0.26 ] , p=0.8 ) . 86 ( 89 % ) of 97 patients in the azithromycin group and 82 ( 89 % ) of 92 in the vitamin C group had returned to their usual activities by day 7 ( difference 0.5 % [ -10 % to 9 % ] , p>0.9 ) . There were no differences in the frequency of adverse effects ; three patients in the vitamin C group discontinued the study medicine because of perceived adverse effects , compared with none in the azithromycin group . Most patients ( 81 % ) reported benefit from the albuterol inhaler . INTERPRETATION Azithromycin is no better than low-dose vitamin C for acute bronchitis . Further studies are needed to identify the best treatment for this disorder BACKGROUND Influenza causes lower respiratory tract complications ( LRTCs ) , particularly bronchitis and pneumonia , in both otherwise healthy adults and those with underlying conditions . The aim of this study was to assess the effect of oseltamivir treatment on the incidence of LRTCs leading to antibiotic treatment and hospitalizations following influenza illness . METHODS We analyzed prospect ively collected data on LRTCs and antibiotic use from 3564 subjects ( age range , 13 - 97 years ) with influenzalike illness enrolled in 10 placebo-controlled , double-blind trials of oseltamivir treatment .  RESULTS In adults and adolescents with a proven influenza illness , oseltamivir treatment reduced overall antibiotic use for any reason by 26.7 % ( 14.0 % vs 19.1 % with placebo ; P<.001 ) and the incidence of influenza-related LRTCs result ing in antibiotic therapy by 55 % ( 4.6 % vs 10.3 % with placebo ; P<.001 ) . In those subjects considered at increased risk of complications , 74 ( 18.5 % ) of 401 placebo recipients developed an LRTC leading to antibiotic use compared with 45 ( 12.2 % ) of 368 oseltamivir recipients ( 34.0 % reduction ; P = .02 ) . Hospitalization for any cause occurred in 18 ( 1.7 % ) of 1063 placebo recipients compared with 9 ( 0.7 % ) of 1350 oseltamivir-treated patients ( 59 % reduction ; P = .02 ) . In contrast , among subjects with an influenzalike illness but without a confirmed influenza infection , the incidence of LRTCs ( 6.7 % vs 5.3 % ) , overall antibiotic use ( 19.7 % vs 19.3 % ) , or hospitalizations ( 1.7 % vs 1.9 % ) was similar between placebo and oseltamivir recipients , respectively . CONCLUSION Oseltamivir treatment of influenza illness reduces LRTCs , antibiotic use , and hospitalization in both healthy and " at-risk " adults OBJECTIVE To evaluate the efficacy and safety of oseltamivir phosphate as treatment for naturally acquired influenza infection . METHODS This study was conducted as a double-blind , r and omized , placebo-controlled , multicenter trial during the influenza epidemic season from January to April 2001 at 7 centers in China . A total of 478 adults without other medical history , aged 18 to 65 years , were enrolled into the study . All subjects demonstrated febrile respiratory illness of no more than 36 hours ' duration with a temperature of 37.8 degrees C or more plus at least two of the following symptoms : coryza/nasal congestion , sore throat , cough , myalgia/muscles aches and pain , fatigue , headache or chills/sweats . Individuals were r and omized into either the oseltamivir phosphate or placebo group with identical-looking capsules . Either oral oseltamivir phosphate , 75 mg twice daily , or placebo was administered to the subjects for 5 days . RESULTS A total of 451 individuals were analyzed for efficacy as the intent-to-treat population ( ITT ) ( 216 oseltamivir and 235 placebo ) and 273 individuals were identified as influenza-infected through laboratory test , who were then defined as the intent-to-treat infected population ( ITTI ) ( 134 oseltamivir and 139 placebo ) . Four hundred and fifty nine individuals were included in the safety analysis . In the ITTI population , the cumulative alleviation proportion of oseltamivir group was significantly higher than that of the placebo group ( P = 0.0466 ) ) . The median duration of illness was 91.6 h [ 95 % confidence interval ( CI ) = 80.2 - 101.3 h ] in the oseltamivir group and 95 h ( 95 % CI = 84.5 - 105.3 h ) in the placebo group . The median area under the curve of decreased total score was significantly higher in the oseltamivir group than in the placebo group , 1382.9 and 1236.7 score-hours , respectively ( P = 0.0196 ) . For the ITT population , similar results were observed . Adverse events ( AE ) were similarly reported in both the oseltamivir group and the placebo group . The main adverse events following test drug were gastrointestinal symptoms , neurological symptoms and rashes . CONCLUSION Oseltamivir was effective and well tolerated as treatment of early naturally acquired influenza We conducted the placebo-controlled double-blind multicenter Phase III trial of newly developed selective oral neuraminidase inhibitor , oseltamivir phosphate ( Ro64 - 0796 ) , in order to evaluate the efficacy and safety , when Ro64 - 0796 was administered orally to both type A and type B influenzavirus infected patients . Patients were r and omly assigned to either Ro64 - 0796 75 mg twice daily group or matching placebo group for five days . A total of 316 patients ( Ro64 - 0796 group ; 154 and placebo group ; 162 ) were recruited , and intent-to-treat infected population , which was defined as the patients that study drug was administered one or more and laboratory-confirmed influenzavirus infection was demonstrated , were 122 and 130 , respectively . Ro64 - 0796 decreased significantly median viral titers after 72 hours ( p = 0.0009 . Analysis of covariance ) , indicating the rapid inhibition of virus replication , and duration of illness which was primary variable of efficacy , was reduced statistically significant by one day ( 23.3 hours ) ( p = 0.0216 , generalized Wilcoxon test ) . Ro64 - 0796 treatment also result ed in the reduction of the fever duration and severity of clinical symptoms . Concerning the safety evaluation , the main accompanied symptoms with Ro64 - 0796 application were gastrointestinal disorders such as bellyache , nausea and vomiting . Most of these events were mild and allowable for the clinical use . There was no abnormal change attributable to Ro64 - 0796 application in the clinical laboratory tests as well as the physiological tests . Our data suggests that Ro64 - 0796 is useful in treating the acute influenzavirus infection In this guideline , evidence is presented and specific recommendations are made about how clinicians can differentiate between bacterial and viral causes of acute bronchitis and about when the use of antibiotics in acute bronchitis is beneficial . The numbers in square brackets are cross-references to the numbered sections in the accompanying background paper , Principles of Appropriate Antibiotic Use for Treatment of Acute Bronchitis in Adults : Background , which is part 2 of this guideline ( see pages 521 - 529 ) . Acute Bronchitis Acute bronchitis is a clinical diagnosis , usually referring to an acute respiratory tract infection in which cough , with or without phlegm , is a predominant feature . The American College of Chest Physicians defines acute cough illness , in contrast to chronic or persistent cough , as lasting less than 3 weeks . As one might expect , there is frequent overlap in how clinicians assign each diagnosis . For example , some clinicians diagnose acute bronchitis only when productive cough is present ; others insist on the presence of purulent sputum [ 1.1 ] . Acute upper respiratory tract infection accounted for approximately 70 % of primary diagnoses in adults presenting for an ambulatory office visit with a chief symptom of cough . Asthma and pneumonia were the next most common diagnoses , assigned to 6 % and 5 % of patients , respectively . Previously undiagnosed asthma is a consideration in patients presenting with an acute cough illness . However , in the setting of acute cough ( < 2 to 3 weeks ' duration ) , the diagnosis of asthma is difficult to establish because of transient bronchial hyperresponsiveness ( and abnormal results on spirometry ) , which many patients with uncomplicated acute bronchitis will have . Since pneumonia is the third most common cause of acute cough illness and potentially the most serious , the primary diagnostic objective should be to exclude the presence of pneumonia [ 1.11.3 ] . Diagnosis An evidence - and quality -based review of four prospect i ve studies evaluating the accuracy of history and physical examination in diagnosing radiographic pneumonia concluded that absence of abnormalities in vital signs ( heart rate 100 beats/min , respiratory rate 24 breaths/min , or oral temperature 38 C ) and chest examination ( focal consolidationfor example , rales , egophony , and fremitus ) sufficiently reduces the likelihood of pneumonia to the point where further diagnostic testing is usually not necessary . Cough lasting longer than 3 weeks exceeds the case definition for acute bronchitis ; such patients should be considered to have persistent cough or chronic cough illness . Irwin and colleagues have developed a well-defined approach to the adult with persistent cough that begins with chest radiography ( 1 ) [ 1.3 , 1.4 ] . As in community-acquired pneumonia , microbiological studies of uncomplicated acute bronchitis identify a pathogen in the minority of cases , ranging from 16 % to 40 % . This variability is most likely due to the epidemic nature of agents that produce uncomplicated acute bronchitis and to limitations in viral and bacterial identification techniques . In epidemiologic studies , respiratory viruses , particularly influenza , appear to cause the majority of cases of uncomplicated acute bronchitis when an agent is sought by culture , antibody serology , or polymerase chain reaction . Specific viruses most frequently associated with acute bronchitis include those that produce primarily lower respiratory tract disease ( influenza B , influenza A , parainfluenza 3 , and respiratory syncytial virus ) , as well as viruses that more commonly produce upper respiratory tract symptoms ( corona virus , adenovirus , and rhinoviruses ) [ 2.1 ] . Unless bacterial superinfection is present ( defined as pneumonia with an infiltrate on chest radiography ) , antibiotic treatment does not affect the clinical course of viral respiratory infection . To date , only Bordetella pertussis , Mycoplasma pneumoniae , and Chlamydia pneumoniae ( TWAR ) have been established as nonviral causes of uncomplicated acute bronchitis in adults . As a group , these agents are associated with 5 % to 10 % of total cases of uncomplicated acute bronchitis in adults . No evidence indicates that Streptococcus pneumoniae , Haemophilus influenzae , or Moraxella catarrhalis produce acute bronchitis in adults without underlying lung disease . Since Gram stain and culture of sputum do not reliably detect M. pneumoniae , C. pneumoniae , or B. pertussis , these tests are not recommended in the evaluation of patients with uncomplicated acute bronchitis [ 2.2 ] . Treatment On the basis of the microbiology of acute bronchitis , it should not be surprising that r and omized , placebo-controlled trials have failed to support a role for antibiotic treatment . By the mid-1990s , published review s of r and omized , placebo-controlled trials had concluded that routine antibiotic treatment of acute bronchitis does not have a consistent impact on duration or severity of illness or on potential complications , such as development of pneumonia . Consistent with these conclusions , the U.S. Food and Drug Administration removed uncomplicated acute bronchitis ( and secondary bacterial infections of acute bronchitis ) as an indication for r 
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There is no evidence that oseltamivir reduces the likelihood of hospitalization , pneumonia or the combined outcome of pneumonia , otitis media and sinusitis in the ITT population