***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: BACKGROUND Acute rheumatic fever is a major cause of heart disease in Aboriginal Australians . The epidemiology differs from that observed in regions with temperate climates ; streptococcal pharyngitis is reportedly rare , and pyoderma is highly prevalent . A link between pyoderma and acute rheumatic fever has been proposed but is yet to be proven . Group C beta-hemolytic streptococci and group G beta-hemolytic streptococci have also been also implicated in the pathogenesis . METHODS Monthly , prospect i ve surveillance of selected households was conducted in 3 remote Aboriginal communities . People were question ed about sore throat and pyoderma ;  swab specimens were obtained from all throats and any pyoderma lesions . Household population density was determined . RESULTS From data collected during 531 household visits , the childhood incidence of sore throat was calculated to be 8 cases per 100 person-years , with no cases of symptomatic group A beta-hemolytic streptococci pharyngitis . The median point prevalence for throat carriage was 3.7 % for group A beta-hemolytic streptococci , 0.7 % for group C beta-hemolytic streptococci , and 5.1 % for group G beta-hemolytic streptococci . Group A beta-hemolytic streptococci were recovered from the throats of 19.5 % of children at some time during the study . There was no seasonal trend or correlation with overcrowding . Almost 40 % of children had pyoderma at least once , and the prevalence was greatest during the dry season . In community 1 , the prevalence of pyoderma correlated with household crowding . Group C and G beta-hemolytic streptococci were rarely recovered from pyoderma lesions . CONCLUSIONS These data are consistent with the hypothesis that recurrent skin infections immunize against throat colonization and infection . High rates of acute rheumatic fever were not driven by symptomatic group A beta-hemolytic streptococci throat infection . Group G and C beta-hemolytic streptococci were found in the throat but rarely in pyoderma lesions BACKGROUND Impetigo affects more than 110 million children worldwide at any one time . The major burden of disease is in developing and tropical setting s where topical antibiotics are impractical and lead to rapid emergence of antimicrobial resistance . Few trials of systemic antibiotics are available to guide management of extensive impetigo . As such , we aim ed to compare short-course oral co-trimoxazole with st and ard treatment with intramuscular benzathine benzylpenicillin in children with impetigo in a highly endemic setting . METHODS In this r and omised , controlled , non-inferiority trial , Indigenous Australian children aged 3 months to 13 years with purulent or crusted non-bullous impetigo were r and omly assigned ( 1:1:1 ) to receive benzathine benzylpenicillin ( weight-b and ed injection ) , twice-daily co-trimoxazole for 3 days ( 4 mg/kg plus 20 mg/kg per dose ) , or once-daily co-trimoxazole for 5 days ( 8 mg/kg plus 40 mg/kg per dose ) . At every visit , participants were r and omised in blocks of six and 12 , stratified by disease severity . R and omisation was done by research nurses and codes were in sealed , sequentially numbered , opaque envelopes . Independent review ers masked to treatment allocation compared digital images of sores from days 0 and 7 . The primary outcome was treatment success at day 7 in a modified intention-to-treat analysis . This trial is registered with the Australian New Zeal and Clinical Trials Registry , number ACTRN12609000858291 . FINDINGS Between Nov 26 , 2009 , and Nov 20 , 2012 , 508 patients were r and omly assigned to receive benzathine benzylpenicillin ( n=165 [ 156 analysed ] ) , twice-daily co-trimoxazole for 3 days ( n=175 [ 173 analysed ] ) , or once-daily co-trimoxazole for 5 days ( n=168 [ 161 analysed ] ) . Treatment was successful in 133 ( 85 % ) children who received benzathine benzylpenicillin and 283 ( 85 % ) who received pooled co-trimoxazole ( absolute difference 0·5 % ; 95 % CI -6·2 to 7·3 ) , showing non-inferiority of co-trimoxazole ( 10 % margin ) . Results for twice-daily co-trimoxazole for 3 days and once-daily co-trimoxazole for 5 days were similar . Adverse events occurred in 54 participants , 49 ( 90 % ) of whom received benzathine benzylpenicillin . INTERPRETATION Short-course co-trimoxazole is a non-inferior , alternative treatment to benzathine benzylpenicillin for impetigo ; it is palatable , pain-free , practical , and easily administered . FUNDING Australian National Health and Medical Research Council BACKGROUND The current resistance pattern of GABHS ( group-A beta-hemolytic streptococci ) in India has not been discussed . AIM To fill the above-mentioned void , we planned this study to determine the prevalence and degree of antibacterial resistance in GABHS isolates . SETTING S AND DESIGN Children with acute pharyngo-tonsillitis who had not received antibiotic in the preceding week , attending the pediatric OPD , were prospect ively enrolled over a period of 1 year . Throat swabs were collected from each child and transported to microbiology laboratory , as early as possible . MATERIAL S AND METHODS A throat swab culture for GABHS was done . All GABHS were subjected to antibiotic susceptibility and minimum inhibitory concentration ( MIC ) test according to Clinical Laboratory St and ard Institute ( CLSI ) guidelines . RESULTS In the present study , 12.6 % ( 55/435 ) of the children with acute pharyngo-tonsillitis had throat swab culture positive for GABHS . The prevalence of macrolide resistance was 10.2 % . The MIC50 for macrolide-resistant strain was 0.5 microg/mL ( range , 0.125 - 8 microg/mL ) , and MIC90 was 8 microg/mL ( range , 0.125 - 8 microg/mL ) . Tetracycline and co-trimoxazole resistances were 24.5 % and 12.2 % respectively . The values of MIC50 for tetracycline- and co-trimoxazole-resistant strains were 4 microg/mL ( range , 0.125 - 32 microg/mL ) and 2 microg/mL ( range , 0.25 - 8 microg/mL ) respectively . All isolates were sensitive to penicillin G and chloramphenicol on disc diffusion test . However , their MIC50 was 0.032 microg/mL ( range , 0.012 - 0.125 microg/mL ) and 2 microg/mL ( range , 0.25 - 4 microg/mL ) respectively . CONCLUSION High prevalence of antimicrobial resistance found among GABHS needs a longitudinal surveillance of isolates from different centers in India BACKGROUND Co-trimoxazole ( fixed-dose trimethoprim-sulfamethoxazole ) prophylaxis administered before antiretroviral therapy ( ART ) reduces morbidity in children infected with the human immunodeficiency virus ( HIV ) . We investigated whether children and adolescents receiving long-term ART in sub-Saharan Africa could discontinue co-trimoxazole . METHODS We conducted a r and omized , noninferiority trial of stopping versus continuing daily open-label co-trimoxazole in children and adolescents in Ug and a and Zimbabwe . Eligible participants were older than 3 years of age , had been receiving ART for more than 96 weeks , were using insecticide-treated bed nets ( in malaria-endemic areas ) , and had not had Pneumocystis jirovecii pneumonia . Co primary end points were hospitalization or death and adverse events of grade 3 or 4 . RESULTS A total of 758 participants were r and omly assigned to stop or continue co-trimoxazole ( 382 and 376 participants , respectively ) , after receiving ART for a median of 2.1 years ( interquartile range , 1.8 to 2.3 ) . The median age was 7.9 years ( interquartile range , 4.6 to 11.1 ) , and the median CD4 T-cell percentage  was 33 % ( interquartile range , 26 to 39 ) . Participants who stopped co-trimoxazole had higher rates of hospitalization or death than those who continued ( 72 participants [ 19 % ] vs. 48 [ 13 % ] ; hazard ratio , 1.64 ; 95 % confidence interval [ CI ] , 1.14 to 2.37 ; P = 0.007 ; noninferiority not shown ) . There was no evidence of variation across ages ( P=0.93 for interaction ) . A total of 2 participants in the prophylaxis-stopped group ( 1 % ) died , as did 3 in the prophylaxis-continued group ( 1 % ) . Most hospitalizations in the prophylaxis-stopped group were for malaria ( 49 events , vs. 21 in the prophylaxis-continued group ) or infections other than malaria ( 53 vs. 25 ) , particularly pneumonia , sepsis , and meningitis . Rates of adverse events of grade 3 or 4 were similar in the two groups ( hazard ratio , 1.20 ; 95 % CI , 0.83 to 1.72 ; P=0.33 ) , but more grade 4 adverse events occurred in the prophylaxis-stopped group ( hazard ratio , 2.04 ; 95 % CI , 0.99 to 4.22 ; P=0.05 ) , with anemia accounting for the largest number of events ( 12 , vs. 2 with continued prophylaxis ) . CONCLUSIONS Continuing co-trimoxazole prophylaxis after 96 weeks of ART was beneficial , as compared with stopping prophylaxis , with fewer hospitalizations for both malaria and infection not related to malaria . ( Funded by the United Kingdom Medical Research Council and others ; ARROW Current Controlled Trials number , IS RCT N24791884 . ) Objective : To evaluate whether cotrimoxazole prophylaxis prevents common skin conditions in HIV-infected children . Design : Open-label r and omized controlled trial of continuing versus stopping daily cotrimoxazole ( post-hoc analysis ) . Setting : Three sites in Ug and a and one in Zimbabwe . Participants : A total of 758 children aged more than 3 years receiving antiretroviral therapy ( ART ) for more than 96 weeks in the ARROW trial were r and omized to stop ( n = 382 ) or continue ( n = 376 ) cotrimoxazole after median ( interquartile range ) 2.1(1.8 , 2.2 ) years on ART . Intervention : Continuing versus stopping daily cotrimoxazole . Main outcome measures : Nurses screened for signs/symptoms at 6-week visits . This was a secondary analysis of ARROW trial data , with skin complaints categorized blind to r and omization as bacterial , fungal , or viral infections ; dermatitis ; pruritic papular eruptions ( PPEs ) ; or others ( blisters , desquamation , ulcers , and urticaria ) . Proportions ever reporting each skin complaint were compared across r and omized groups using logistic regression . Results : At r and omization , median ( interquartile range ) age was 7 ( 4 , 11 ) years and CD4 + was 33 % ( 26 , 39 ) ; 73 % had WHO stage 3/4 disease . Fewer children continuing cotrimoxazole reported bacterial skin infections over median 2 years follow-up ( 15 versus 33 % , respectively ; P < 0.001 ) , with similar trends for PPE ( P = 0.06 ) and other skin complaints ( P = 0.11 ) , but not for fungal ( P = 0.45 ) or viral ( P = 0.23 ) infections or dermatitis ( P = 1.0 ) . Bacterial skin infections were also reported at significantly fewer clinic visits ( 1.2 versus 3.0 % , P < 0.001 ) . Independent of cotrimoxazole , bacterial skin infections were more common in children aged 6–8 years , with current CD4 + cell count less than 500 cells/&mgr;l , WHO stage 3/4 , less time on ART , and lower socio-economic status . Conclusion : Long-term cotrimoxazole prophylaxis reduces common skin complaints , highlighting an additional benefit for long-term prophylaxis in sub-Saharan Africa EXECUTIVE SUMMARY Soft-tissue infections are common , generally of mild tomodest severity , and are easily treated with a variety ofagents . An etiologic diagnosis of simple cellulitis is fre-quently difﬁ 
    Output:
    
These findings support SXT use for treatment of impetigo and purulent cellulitis ( without an additional β-lactam agent ) and abscess and wound infection .
For nonpurulent cellulitis , β-lactams remain the treatment of choice