***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: Jeremy Keenan and colleagues report that during a cluster-r and omized clinical trial in Ethiopia , nasopharyngeal pneumococcal resistance to macrolides was significantly higher in communities r and omized to receive azithromycin compared with untreated control communities ABSTRACT Mean fecal global yeast counts increased similarly during 7 days of treatment with telithromycin ( 800 mg once daily ) or amoxicillin-clavulanic acid ( amoxiclav ) ( 1 g of amoxicillin and 125 mg of clavulanic acid 3 times daily ) in human volunteers and decreased slowly thereafter . On skin , coagulase-negative staphylococci of decreased susceptibility ( DS ) to telithromycin increased in the telithromycin group , whereas those with DS to methicillin increased in the amoxiclav group . A similar antibiotic-related shift towards homologous DS was observed for oral nongroupable streptococci ( NGS ) , but in addition , the prevalence of NGS resistant to both classes of antibiotics was significantly greater in the amoxiclav group at days 8 ( P < 0.01 ) and 45 ( P < 0.015 ) Background Synthesis of multiple r and omized controlled trials ( RCTs ) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions . Filtering of search es is time consuming , and no single method fulfills the principal requirements of speed with accuracy . Automation of systematic review s is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making . We developed Rayyan ( http://rayyan.qcri.org ) , a free web and mobile app , that helps expedite the initial screening of abstract s and titles using a process of semi-automation while incorporating a high level of usability . For the beta testing phase , we used two published Cochrane review s in which included studies had been selected manually . Their search es , with 1030 records and 273 records , were uploaded to Rayyan . Different features of Rayyan were tested using these two review s. We also conducted a survey of Rayyan ’s users and collected feedback through a built-in feature . Results Pilot testing of Rayyan focused on usability , accuracy against manual methods , and the added value of the prediction feature . The “ taster ” review ( 273 records ) allowed a quick overview of Rayyan for early comments on usability . The second review ( 1030 records ) required several iterations to identify the previously identified 11 trials . The “ suggestions ” and “ hints , ” based on the “ prediction model , ” appeared as testing progressed beyond five included studies . Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements . The survey respondents reported 40 % average time savings when using Rayyan compared to others tools , with 34 % of the respondents reporting more than 50 % time savings . In addition , around 75 % of the respondents mentioned that screening and labeling studies as well as collaborating on review s to be the two most important features of Rayyan . As of November 2016 , Rayyan users exceed 2000 from over 60 countries conducting hundreds of review s totaling more than 1.6 M citations . Feedback from users , obtained mostly through the app web site and a recent survey , has highlighted the ease in exploration of search es , the time saved , and simplicity in sharing and comparing include-exclude decisions . The strongest features of the app , identified and reported in user feedback , were its ability to help in screening and collaboration as well as the time savings it affords to users . Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of review ers ABSTRACT To investigate the effect of slow-release ( SR ) clarithromycin on colonization and the development of resistance in oropharyngeal and nasal flora , a double-blind , r and omized , placebo-controlled trial was performed with 8 weeks of follow-up . A total of 296 patients with documented coronary artery disease were r and omized in the preoperative outpatient clinic to receive a daily dose of SR clarithromycin ( 500 mg ) ( CL group ) or placebo tablets ( PB group ) until the day of surgery . Nose and throat swabs were taken before the start of therapy , directly after the end of therapy , and 8 weeks later . The presence of potential pathogenic bacteria was determined , and if they were isolated , MIC testing was performed . Quantitative culture on media with and without macrolides was performed for the indigenous oropharyngeal flora . In addition , analysis of the mechanism of resistance was performed with the macrolide-resistant indigenous flora . Basic patient characteristics were comparable in the two treatment groups . The average number of tablets taken was 15 ( st and ard deviation = 6.4 ) . From the throat swabs , Haemophilus parainfluenzae was isolated and carriage was not affected in either of the treatment groups . Nasal carriage of Staphylococcus aureus , however , was significantly reduced in the CL group ( from 35.3 to 4.3 % ) compared to the PB group ( from 32.4 to 30.3 % ) ( P < 0.0001 ; relative risk [ RR ] , 7.0 ; 95 % confidence interval [ CI ] , 3.1 to 16.0 ) . Resistance to clarithromycin  was present significantly more frequently in H. parainfluenzae in the CL group after treatment ( P = 0.007 ; RR , 1.6 ; 95 % CI , 1.1 to 2.3 ) ; also , the percentage of patients with resistance to macrolides in the indigenous flora after treatment was significantly higher in the CL group ( 31 to 69 % ) ( P < 0.0001 ; RR , 1.9 ; 95 % CI , 1.4 to 2.5 ) . This persisted for at least 8 weeks . This study shows that besides the effective elimination of nasal carriage of S. aureus , treatment with SR clarithromycin for approximately 2 weeks has a marked and sustained effect on the development of resistance in the oropharyngeal flora for at least 8 weeks BACKGROUND Acute otitis media is the leading reason for  antibiotic prescriptions in childhood . The increase in antibiotic resistance of Streptococcus pneumoniae is generally attributed to the extensive use of antibiotics and the selective pressure on the bacterial strains of the nasopharyngeal flora . OBJECTIVE To evaluate the change in nasopharyngeal carriage of S. pneumoniae during antibiotic therapy prescribed for acute otitis media . METHODS Between October , 1993 , and March , 1994 , we conducted a clinical trial comparing cefpodoxime-proxetil and amoxicillin-clavulanate in acute otitis media . From 364 children , 4 months to 4.5 years old , a nasopharyngeal sample was obtained before and after treatment . Antibiotic susceptibility was established by determining minimal inhibitory concentrations by the agar dilution method . Serotype and r and omly amplified polymorphic DNA analysis were used to compare pre- and posttreatment S. pneumoniae strains . RESULTS The risk for a child to carry penicillin-resistant S. pneumoniae ( MIC > or = 0.125 mg/l ) did not increase after antibiotic treatment : 84 of 364 ( 23.1 % ) before , 70 of 364 ( 19.2 % ) after . There was a significant decrease of penicillin-susceptible S. pneumoniae carriage , 117 of 364 ( 32.1 % ) before treatment compared with 24 of 364 ( 6.6 % ) ( P = 0.0001 ) after treatment . However , among the children carrying S. pneumoniae at the end of the treatment there was an increase in the percentage of penicillin-resistant pneumococci : 84 of 201 ( 41.8 % ) before treatment and 70 of 94 ( 74.5 % ) after treatment . Among the 94 children carrying S. pneumoniae at the end of the treatment , 22 did not harbor pneumococcus before , 16 carried another genotypically different serotype and 56 harbored the same serotype . Among these 56 children 2 patients harbored strains that had increased MICs for the tested beta-lactam antibiotics . The r and omly amplified polymorphic DNA analysis showed that in one case , the strains were genetically different . CONCLUSIONS These data illustrate that antibiotic therapy did not increase the rate at which children carried penicillin-resistant S. pneumoniae , but there was an increase in the rate of resistance among the children carrying pneumococci at the end of the treatment , mainly as a result of reduction of susceptible strains Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more PURPOSE To assess the ecologic impact , in terms of selection of beta-lactamase-producing respiratory tract bacteria , of a single course of peroral beta-lactam antibiotics . PATIENTS AND METHODS One-hundred fifty consecutive children with clinical signs of bacterial respiratory tract infection were r and omly assigned to a seven-day course of treatment with either penicillin V , amoxicillin , or cefaclor . Bacteriologic specimens were collected before treatment , at its termination , and at follow-up four weeks later . RESULTS All three drugs investigated caused a similar increase in beta-lactamase-producing bacteria , both in absolute and relative terms , an increase that persisted over a period of at least one month after completion of treatment . CONCLUSION Penicillin V , amoxicillin , and cefaclor all act as selective agents for beta-lactamase-producing bacteria in the upper respiratory tract . Treatment with a peroral beta-lactam antibiotic puts patients at risk of becoming persistent carriers of beta-lactamase-producing bacteria CONTEXT Emerging drug resistance threatens the effectiveness of existing therapies for pneumococcal infections . Modifying the dose and duration of antibiotic therapy may limit the spread of resistant pneumococci . OBJECTIVE To determine whether short-course , high-dose amoxicillin therapy reduces risk of posttreatment resistant pneumococcal carriage among children with respiratory tract infections . DESIGN AND SETTING R and omized trial conducted in an outpatient clinic in Santo Domingo , Dominican Republic , October 1999 through July 2000 . PARTICIPANTS Children aged 6 to 59 months who were receiving antibiotic prescriptions for respiratory tract illness ( n = 795 ) . INTERVENTIONS Children were r and omly assigned to receive 1 of 2 twice-daily regimens of amoxicillin : 90 mg/kg per day for 5 days ( n = 398 ) or 40 mg/kg per day for 10 days ( n = 397 ) . MAIN OUTCOME MEASURES Penicillin-nonsusceptible Streptococcus pneumoniae carriage , assessed in nasopharyngeal specimens collected at days 0 , 5 , 10 , and 28 ; baseline risk factors for nonsusceptible pneumococcal carriage ; and adherence to regimen , compared between the 2 groups . RESULTS At the day 28 visit , risk of penicillin-nonsusceptible pneumococcal carriage was significantly lower in the short-course , high-dose group ( 24 % ) compared with the st and ard-course group ( 32 % ) ; relative risk ( RR ) , 0.77 ; 95 % confidence interval ( CI ) , 0.60 - 0.97 ; P = .03 ; risk of trimethoprim-sulfamethoxazole nonsusceptibility was also lower in the short-course , high-dose group ( RR , 0.77 ; 95 % CI , 0.58 - 1.03 ; P = .08 ) . The protective effect of short-course , high-dose therapy was stronger in households with 3 or more children ( RR , 0.72 ; 95 % CI , 0.52 - 0.98 ) . Adherence to treatment was higher in the short-course , high-dose group ( 82 % vs 74 % ; P = .02 ) . CONCLUSION Short-course , high-dose outpatient antibiotic therapy appears promising as an intervention to minimize the impact of antibiotic use on the spread of drug-resistant pneumococci Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies We conducted a multicenter prospect i ve study to document changes in nasopharyngeal carriage of Streptococcus pneumoniae , Haemophilus influenzae , and Branhamella catarrhalis during antibiotic therapy . A cohort of 629 children with respiratory tract infections underwent nasopharyngeal sampling before and 
    Output:
    
Conclusions Resistance generally increased soon after antibiotic use .