***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: Respiratory syncytial virus ( RSV ) bronchiolitis is the most common lower respiratory tract infection in infancy . To date , there is no effective therapy for RSV bronchiolitis . In order to investigate the efficacy of clarithromycin in the treatment of RSV bronchiolitis , the present authors conducted a r and omised , double-blind , placebo-controlled trial comparing clarithromycin with placebo in 21 infants with a diagnosis of RSV bronchiolitis . The infants were r and omised to receive clarithromycin or placebo daily for 3 weeks . Levels of interleukin (IL)-4 , IL-8 , eotaxin , and interferon-γ were determined in plasma , before and after treatment , using ELISA . Six months after treatment , parents were surveyed as to whether their child had experienced wheezing within the previous 6 months . Treatment with clarithromycin was associated with a statistically significant reduction in the length of hospital stay , the duration of need for supplemental oxygen and the need for β2-agonist treatment . There were significant decreases in plasma IL-4 , IL-8 and eotaxin levels after 3 weeks of treatment with clarithromycin  . Readmission to the hospital within 6 months after discharge was significantly lower in the clarithromycin group . In conclusion , clarithromycin has statistically significant effects on the clinical and laboratory findings in respiratory syncytial virus bronchiolitis . Therefore , clarithromycin treatment may be helpful in reducing the short-term effects of respiratory syncytial virus bronchiolitis Background : Respiratory syncytial virus ( RSV ) is the most common cause of viral lower respiratory tract infections ( LRTI ) . Viral LRTI is a risk factor for bacterial superinfection , having an escalating incidence with increasing severity of respiratory illness . A study was undertaken to determine the incidence of pulmonary bacterial co-infection in infants and children with severe RSV bronchiolitis , using paediatric intensive care unit ( PICU ) admission as a surrogate marker of severity , and to study the impact of the co-infection on morbidity and mortality . Methods : A prospect i ve microbiological analysis was made of lower airways secretions on all RSV positive bronchiolitis patients on admission to the PICU during three consecutive RSV seasons . Results : One hundred and sixty five children ( median age 1.6 months , IQR 0.5–4.6 ) admitted to the PICU with RSV bronchiolitis were enrolled in the study . Seventy ( 42.4 % ) had lower airway secretions positive for bacteria : 36 ( 21.8 % ) were co-infected and 34 ( 20.6 % ) had low bacterial growth/possible co-infection . All were mechanically ventilated ( median 5.0 days , IQR 3.0–7.3 ) . Those with bacterial co-infection required ventilatory support for longer than those with only RSV ( p<0.01 ) . White cell count , neutrophil count , and C-reactive protein did not differentiate between the groups . Seventy four children ( 45 % ) received antibiotics prior to intubation . Sex , co-morbidity , origin , prior antibiotics , time on preceding antibiotics , admission oxygen , and ventilation index were not predictive of positive bacterial cultures . There were 12 deaths ( 6.6 % ) , five of which were related to RSV . Conclusions : Up to 40 % of children with severe RSV bronchiolitis requiring admission to the PICU were infected with bacteria in their lower airways and were at increased risk for bacterial pneumonia Routine administration of antibiotics in the treatment of pneumonia and bronchiolitis in infants and small children was evaluated in an open r and omised prospect i ve trial . From 1979 - 82 136 children between the age of 1 month and 6 years were allocated to one of two treatment groups shortly after their admission to a paediatric ward . Group A patients were to be given antibiotics but those in group B were not . None of the children had received antibiotics before hospital admission . A viral infection was diagnosed in 38 of the 72 patients from group A and in 34 of the 64 patients from group B. Respiratory syncytial virus was detected in 84 % of these patients . Sample s of tracheal secretions showed no differences between the groups in respect of cytology and bacterial flora . Nor were there any significant differences in the course of acute disease , the frequency of fever relapse and pulmonary complications . Fifteen patients from group B were subsequently treated with antibiotics : two of these developed secondary purulent infections of the middle ear and one showed a slight pleural effusion . These results do not support the routine use of antibiotics in infants and small children admitted to hospital with pneumonia and bronchiolitis OBJECTIVES . The goals were to describe the ( 1 ) frequency of sepsis evaluation and empiric antibiotic treatment  , ( 2 ) clinical predictors of management , and ( 3 ) serious bacterial illness frequency for febrile infants with clinical ly diagnosed bronchiolitis seen in office setting s. METHODS . The Pediatric Research in Office Setting s network conducted a prospect i ve cohort study of 3066 febrile infants ( <3 months of age with temperatures ≥38 ° C ) in 219 practice s in 44 states . We compared the frequency of  sepsis evaluation , parenteral antibiotic treatment , and serious bacterial illness  in infants with and without clinical ly diagnosed bronchiolitis . We identified predictors of  sepsis evaluation and parenteral antibiotic treatment in infants with bronchiolitis by using logistic regression models . RESULTS . Practitioners were less likely to perform a complete sepsis evaluation , urine testing , and cerebrospinal fluid culture and to administer parenteral antibiotic treatment for infants with bronchiolitis , compared with those without bronchiolitis . Significant predictors of sepsis evaluation in infants with bronchiolitis included younger age , higher maximal temperature , and respiratory syncytial virus testing . Predictors of parenteral antibiotic use included initial ill appearance , age of < 30 days , higher maximal temperature , and general signs of infant distress . Among infants with bronchiolitis ( N = 218 ) , none had serious bacterial illness and those with respiratory distress signs were less likely to receive parenteral antibiotic treatment . Diagnoses among 2848 febrile infants without bronchiolitis  included bacterial meningitis ( n = 14 ) , bacteremia ( n = 49 ) , and urinary tract infection ( n = 167 ) . CONCLUSIONS . In office setting s , serious bacterial illness in young febrile infants with clinical ly diagnosed bronchiolitis is uncommon . Limited testing for bacterial infections seems to be an appropriate management strategy BACKGROUND Nearly half of all hospitalized infants with respiratory syncytial virus ( RSV ) lower respiratory tract disease ( LRTD ) are treated with ( parenteral ) antibiotics . The present study was design ed to test our hypothesis that the use of antibiotics would not lead to a reduced duration of hospitalization in mild to moderate RSV LRTD . METHODS Seventy-one patients < or = 24 months of age with a virologically confirmed clinical diagnosis of RSV LRTD were r and omized to azithromycin 10 mg/kg/day ( n = 32 ) or placebo ( n = 39 ) in a multicenter , r and omized , double-blind , placebo-controlled equivalence trial during three RSV seasons ( 2002 - 2004 through 2005 - 2006 ) . Primary endpoint was duration of hospitalization , secondary endpoints included duration of oxygen supplementation and nasogastric tube feeding , course of RSV symptom score , number of PICU referrals and number of patients who received additional antibiotic treatment . Data were analyzed according to the intention-to-treat principle using the Mann-Whitney U-test or chi2 test considering P < 0.05 as statistically significant . RESULTS Included patients were comparable with respect to baseline demographics , clinical characteristics , laboratory and roentgenologic investigations . The mean duration of hospitalization was not significantly different between patients treated with azithromycin or placebo ( 132.0 + /- 10.8 vs. 139.6 + /- 7.7 hr , P = 0.328 ) . Azithromycin was not associated with a stronger resolution of clinical symptoms represented by the RSV symptom score . Four patients were treated with antibiotics after 72 hr , three of them were assigned to placebo ( P = 0.406 ) . CONCLUSIONS Infants and young children with RSV LRTD do not benefit from routine treatment with antibiotics ( IS RCT N number 86554663 ) OBJECTIVES To determine the current management of bronchiolitis by five major New Zeal and hospitals and to identify areas for improvement . METHODS Lists of infants under 1 year of age admitted with bronchiolitis during 1998 were obtained from the casemix offices of the five largest New Zeal and hospitals with paediatric services . Hospital records from a r and om sample of these admissions were review ed . RESULTS Out of the 409 infants admitted overnight , 8 % had been born less than or=32 weeks gestation and 53 % were aged younger than 6 months . Overall , 59 % received oxygen , 21 % had nasogastric fluids , 22 % had intravenous fluids , 34 % were prescribed  antibiotics  , 42 % received bronchodilators and 60 % had a chest radiograph . Respiratory secretions were collected for viral studies from 58 % of infants and , in 59 % , respiratory syncytial virus was detected . Significant variations in management were detected between hospitals . The overall proportion of infants requiring oxygen , intravenous or nasogastric fluids  ( 65 % ) was significantly higher than that found in a 1986 - 1988 Christchurch study where only 25 % received one or more of these interventions ( P < 0.001 ) . CONCLUSIONS Opportunities exist to rationalize bronchiolitis management in New Zeal and with potential cost savings , particularly by reducing the number of chest radiographs and prescribing of unnecessary antibiotics and bronchodilators Aims : To examine the frequency of and risk factors for bacteraemia in children hospitalised with respiratory syncytial virus ( RSV ) infection ; and to determine current use of antibiotics in hospitalised children with RSV infection . Methods : Retrospective study of all children , aged 0–14 years , admitted to a tertiary children ’s hospital with proven RSV infection over a four year period . Children with concurrent bacteraemia and RSV infection were identified , and risk factors examined for bacteraemia . The case notes of a r and omly selected comparison sample of 100 of these RSV infected children were examined to assess  antibiotic use and population incidence of risk factors for severe RSV infection . Results : A total of 1795 children had proven RSV infection , and blood cultures were sent on 861 ( 48 % ) . Eleven ( 0.6 % ) of the 1795 RSV positive children had bacteraemia . RSV positive children had a significantly higher incidence of bacteraemia if they had nosocomial RSV infection ( 6.5 % ) , cyanotic congenital heart disease ( 6.6 % ) , or were admitted to the paediatric intensive care unit ( 2.9 % ) . Forty five ( 45 % ) of the r and om comparison sample of RSV infected children received antibiotics . Conclusions : Bacteraemia is rare in RSV infection . Children with RSV infection are more likely to be bacteraemic , however , if they have nosocomial RSV infection , cyanotic congenital heart disease , or require intensive care unit admission arthritis , particularly with actively inflamed large joints , and ankylosing spondylitis . The fact that indomethacin is a rapidly effective , non-steroidal , anti-inflammatory agent , like phenylbutazone , makes it a useful alternative to predni-steroid therapy . As with many other drugs used in the treatment of chronic rheumatic disorders , indomethacin causes undesired effects which are particularly apt to occur in the early stages of treatment . Fortunately most of these are trivial and clear rapidly after withdrawal of the drug . In view of the occurrence of severe neurological disturbance in seven of our cases we feel that it would be unwise to ignore and dangerous to suppress the headache and associated symptoms so commonly encountered . If these can not be avoided by gradual induction or by subsequent reduction of dosage , they must be taken as an indication for stopping the drug . It would seem reasonable to insist that indomethacin should only be given with caution to any patient with a history of depressive illness . Active or recent peptic ulceration should be regarded as an absolute contraindication , and therapy should not be resumed in any patient who exhibits a rash during treatment BACKGROUND Treatment of hospitalized infants with respiratory syncytial virus ( RSV ) bronchiolitis is mainly supportive . Bronchodilators and systemic steroids are often used but do not reduce the length of hospital stay . Because hypoxia and airways obstruction develop secondary to viscous mucus in infants with RSV bronchiolitis , and because free DNA is present in RSV mucus , we tested the efficacy of the mucolytic drug recombinant human deoxyribonuclease ( rhDNase ) . METHODS In a multicenter , r and omized , double-blind , controlled clinical trial , 225 oxygen-dependent infants admitted to the hospital for RSV 
    Output:
    
AUTHORS ' CONCLUSIONS This review found minimal evidence to support the use of antibiotics for bronchiolitis .