***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: Abstract Objective : To assess three prescribing strategies for sore throat .  Design : R and omised follow up study . Setting : 11 general practice s in the South and West region . Subjects : 716 patients aged 4 years and over with sore throat and an abnormal physical sign in the throat ; 84 % had tonsillitis or pharyngitis . Patients were r and omised to three groups : prescription for antibiotics for 10 days ( group 1 , 246 patients ) ; no prescription ( group 2 , 230 patients ) ; or prescription for antibiotics if symptoms were not starting to settle after three days ( group 3 ; 238 patients ) . Main outcome measures : Duration of symptoms ; satisfaction and compliance with and perceived efficacy of antibiotics ; time off school or work . Outcomes were documented in 582 subjects ( 81 % ) . Results : Median duration of antibiotic use differed significantly in the three groups ( 10 v 0 v 0 days , P<0.001 ) ; 69 % of patients in group 3 did not use their prescription . The proportion of patients better by day 3 did not differ significantly ( 37 % v 35 % v 30 % , P=0.28 ) , nor did the duration of illness ( median 4 v 5 v 5 days , P=0.39 ) , days off work or school ( median 2 v 2 v 1 , P=0.13 ) , or proportion of patients satisfied ( 96 % v 90 % v 93 % , P=0.09 ) , although group 1 had fewer days of fever ( median 1 v 2 v 2 days , P=0.04 ) . More patients in group 1 thought the antibiotics were effective ( 87 % v 55 % v 60 % , P<0.001 ) and intended coming to the doctor in future attacks ( 79 % v 54 % v 57 % , P<0.001 ) . “ Legitimation ” of illness — to explain to work or school ( 60 % ) or family or friends (37%)–was an important reason for consultation . Patients who were more satisfied got better more quickly , and satisfaction related strongly to how well the doctor dealt with patient 's concerns . Conclusion : Prescribing antibiotics for sore throat only marginally affects the resolution of symptoms but enhances belief in antibiotics and intention to consult in future when compared with the acceptable strategies of no prescription or delayed prescription . Psychosocial factors are important in the decision to see a general practitioner and in predicting the duration of illness . Key messages Sore throat is one of the commonest presentations of upper respiratory illness to general practitioners , and attendance is increasing Prescribing antibiotics for sore throat does not reduce the extent and duration of symptoms Prescribing antibiotics enhances belief in antibiotics and intention to consult Legitimation of illness is an important reason for attending the doctor Satisfaction predicts duration of illness and closely relates to how well concerns are dealt with — unless patients are very ill , general practitioners should consider exploring concerns and should avoid or delay prescribing Three hundred six children with probable Group A beta-hemolytic streptococcal pharyngitis were enrolled in a r and omized double blind trial to compare the effects of immediate vs. delayed treatment with oral penicillin V. Among the 229 culture-positive patients , 111 were r and omly assigned to receive penicillin V immediately and 118 to receive a placebo for 48 to 52 hours followed by penicillin V. Patients were evaluated clinical ly for 48 to 52 hours following initiation of treatment . The Streptozyme test was used to measure acute to convalescent antibody titer . Both regimens result ed in a greater than 92 % cure rate . Early treatment was associated with significantly fewer and milder signs and symptoms on Day 3 and a significantly lower rise in the antibody titer . On the other h and we found 8 ( 7 % ) relapses and 18 ( 16 % ) early and 14 ( 13 % ) late recurrences in this group ; all were significantly higher than the corresponding numbers of 2 ( 2 % ) , 6 ( 5 % ) and 4 ( 3 % ) , respectively , in the late treatment group . This study shows the beneficial effect of early treatment with penicillin V on the clinical course of Group A beta-hemolytic streptococcal pharyngitis . This study also shows that delayed penicillin treatment may be associated with a lower incidence of subsequent Group A beta-hemolytic streptococcal pharyngitis Abstract Objective To assess how pressures from patients on doctors in the consultation contribute to referral and investigation . Design Observational study nested within a r and omised controlled trial . Setting Five general practice s in three setting s in the United Kingdom . Participants 847 consecutive patients , aged 16 - 80 years . Main outcomes measures Patient preferences and doctors ' perception of patient pressure and medical need . Results Perceived medical need was the strongest independent predictor of all behaviours and confounded all other predictors . The doctors thought , however , there was no or only a slight indication for medical need among a significant minority of those who were examined ( 89/580 , 15 % ) , received a prescription ( 74/394 , 19 % ) , or were referred ( 27/125 , 22 % ) and almost half of those investigated ( 99/216 , 46 % ) . After controlling for patient preference , medical need , and clustering by doctor , doctors ' perceptions of patient pressure were strongly associated with prescribing ( adjusted odds ratio 2.87 , 95 % confidence interval 1.16 to 7.08 ) and even more strongly associated with examination ( 4.38 , 1.24 to 15.5 ) , referral ( 10.72 , 2.08 to 55.3 ) , and investigation ( 3.18 , 1.31 to 7.70 ) . In all cases , doctors ' perception of patient pressure was a stronger predictor than patients ' preferences . Controlling for r and omisation group , mean consultation time , or patient variables did not alter estimates or inferences . Conclusions Doctors ' behaviour in the consultation is most strongly associated with perceived medical need of the patient , which strongly confounds other predictors . However , a significant minority of examining , prescribing , and referral , and almost half of investigations , are still thought by the doctor to be slightly needed or not needed at all , and perceived patient pressure is a strong independent predictor of all doctor behaviours . To limit unnecessary re source use and iatrogenesis , when management decisions are not thought to be medically needed , doctors need to directly ask patients about their expectations Abstract Objective : To compare immediate with delayed prescribing of antibiotics for acute otitis media . Design : Open r and omised controlled trial . Setting : General practice s in south west Engl and . Participants : 315 children aged between 6 months and 10 years presenting with acute otitis media . Interventions : Two treatment strategies , supported by st and ardised advice sheets — immediate antibiotics or delayed antibiotics ( antibiotic prescription to be collected at parents ' discretion after 72 hours if child still not improving ) . Main outcome measures : Symptom resolution , absence from school or nursery , paracetamol consumption . Results : On average , symptoms resolved after 3 days . Children prescribed antibiotics immediately had shorter illness ( −1.1 days ( 95 % confidence interval −0.54 to −1.48 ) ) , fewer nights disturbed ( −0.72 ( −0.30 to −1.13 ) ) , and slightly less paracetamol consumption ( −0.52 spoons/day ( −0.26 to −0.79 ) ) . There was no difference in school absence or pain or distress scores since benefits of antibiotics occurred mainly after the first 24 hours — when distress was less severe . Parents of 36/150 of the children given delayed prescriptions used antibiotics , and 77 % were very satisfied . Fewer children in the delayed group had diarrhoea ( 14/150 ( 9 % ) v 25/135 ( 19 % ) , χ2=5.2 , P=0.02 ) . Fewer parents in the delayed group believed in the effectiveness of antibiotics and in the need to see the doctor with future episodes . Conclusion : Immediate antibiotic prescription provided symptomatic benefit mainly after first 24 hours , when symptoms were already resolving . For children who are not very unwell systemically , a wait and see approach seems feasible and acceptable to parents and should substantially reduce the use of antibiotics for acute otitis media Otitis media ( OM ) is one of the most common diseases of childhood , and causes both direct and indirect costs to families and to society . This study calculated the costs arising from OM among 736 day care children whose infections were prospect ively monitored for up to 15 mo in 10 day care centres in the city of Oulu . The children in the survey had 1.5 attacks of acute OM per person year , made 2.1 visits to a physician ( cost $ US55 visit−1 ) and received 1.5 courses of antimicrobials ( cost $ 24 course−1 ) . Their parents were absent from work for 1.9 d per person year ( cost $ 85 d−1 ) . Either adenoidectomy ( $ 890 operation−1 ) or tympanostomy ( $ 740 ) was performed on 6 % of the children and the overall costs of surgery were $ 80 per person year at risk . In total , each single attack of acute OM cost $ 228 . The average annual costs per child younger than 2y were $ 1040 , those for children aged 2—3 y $ 283 and those for children older than 3 y $ 141 . The cumulative costs from age 6 mo to 7y were $ 2549 child−1 . When the attributable risk of OM at a day care centre is taken into account , in Finl and , a country with about 5 million inhabitants , OM gives rise to total annual costs of $ US138 million . OM leads to considerable expenses and even expensive preventive measures would be cost‐effective . □ Adenoidectomy , cost analysis , otitis media , OBJECTIVE To explore the experiences and opinions of family physicians and patients regarding the delay of antibiotic prescriptions , to be dispensed if symptoms persist or worsen over time , in treating upper respiratory tract infections . STUDY DESIGN Qualitative study using semistructured interviews conducted in family practice in Auckl and , New Zeal and . POPULATION Thirteen physicians recruited from a study of family physicians ' reported antibiotic prescribing and 13 patients recruited from the intervention arm of a r and omized controlled trial on delayed antibiotic prescribing .  OUTCOMES MEASURED Patients ' and physicians ' experiences of delayed  antibiotic prescriptions  for upper respiratory tract infections . RESULTS The primary themes identified were value judgments of antibiotics , decreased antibiotic use , patient-centered factors , effects on the physician-patient relationship , patient convenience , adverse effects of delaying prescription , and selectivity for use of antibiotics . Many themes were common to both patients and physicians . Physicians valued empowering patients ' decision making about their health care management more highly than did patients . Decreasing antibiotic use was not a key factor for most patients . Both groups acknowledged the value in saving patients time and money . Physicians viewed the strategy as giving patients reassurance and meeting their expectations for antibiotics . Negative implication s included perception of physician incompetence and physician loss of management control . Opinions were mixed regarding which patients , under which conditions , were suitable for delayed antibiotic prescriptions . CONCLUSIONS Although delayed antibiotic prescriptions are effective in decreasing antibiotic use for conditions not clinical ly warranting antibiotics , neither patients nor physicians universally endorsed this strategy . Research to establish formalized recommendations for patient suitability and instructions for use would be of value Two recent review s question ed the routine use of antibiotics in the initial management of  acute otitis media .  1 2 My practice partners and I responded to the review s by changing our policy , with the aim of reducing such prescribing in children . We measured the change one year after adopting the new policy . From July 1997 my practice partners and I changed our policy on routine prescription of antibiotics in the initial management of  acute otitis media in children . In children who were not particularly ill we gave the parents a h and out that summarised the limited benefit of antibiotics on the basis of the data presented in the Cochrane review .1 We advised parents to give regular paracetamol suspension ; we also offered an antibiotic prescription but asked the parents to keep it for a day or two . They could redeem it at a pharmacy if the child did not got better over this period . A local practice acted as a concurrent control . Both practice s use One hundred forty-two children with presumed Group A beta-hemolytic streptococcal ( GABHS ) pharyngitis were enrolled in a r and omized double blind prospect i ve study comparing the consequences of immediate penicillin treatment with treatment delayed for 48 to 56 hours . One hundred fourteen of the enrolled patients were culture-positive . An adverse impact of early antibiotic therapy was noted ; the incidence of subsequent infections with GABHS was significantly greater in those treated at the initial office visit with penicillin . In the month following documented evaluation of GABHS , a recurrence occurred 2 times more frequently in those treated with penicillin immediately compared with those for whom treatment was delayed 48 to 56 hours . Late recurrences ( beyond 1 month but in the same streptococcal season ) occurred 8 times more frequently ( P less than 0.035 ) . Delay in penicillin treatment did not increase GABHS intrafamilial spread . Symptoms of both groups were assessed for 2 days 
    Output:
    
There was no difference between immediate and delayed antibiotic groups for symptoms on day one and day seven .
For most symptom measures there was no significant difference between the immediate and delayed antibiotic groups .
Pain and malaise severity scores at day three significantly favoured the immediate antibiotic group in children with acute otitis media ( Little 2001 ) .
Most symptom outcomes show no difference between immediate and delayed antibiotic groups .
There is evidence indicating that for children with otitis media , pain and malaise scores are worse in the delayed antibiotic group compared to the immediate antibiotic group .