***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 tract pathogens ( beta-haemolytic streptococci groups A , C and G , Haemophilus influenzae , Branhamella catarrhalis or pneumococci ) , were isolated from nasopharyngeal and /or throat swabs in 73/138 ( 53 % ) patients greater than 10 years of age with a clinical diagnosis of acute sinusitis , acute tonsillitis , purulent nasopharyngitis or acute bronchitis . Serological evidence of a viral infection ( influenza A and B , parainfluenza 1 , 2 and 3 , respiratory syncytial virus , adenovirus ) or Mycoplasma pneumoniae infection was found in 10 % of the patients . The serum content of C-reactive protein ( S-CRP ) was increased ( greater than 12 mg/l ) in 26/33 ( 79 % ) patients with streptococci and in 22/59 ( 37 % ) patients without respiratory tract bacteria . In patients with a serological evidence of a virus tonsillitis , the S-CRP was also high ( 32 - 64 mg/l ) . At follow-up 10 - 12 days after the first visit , the clinical effect of erythromycin and penicillin V was judged to be similar ( 90 % clinical effect ) . Relapse or re-infection with group A streptococci were seen in 7 patients ( 4 on erythromycin , 3 on penicillin ) . In another 6 patients ( 3 on erythromycin , 3 on penicillin ) , antibiotic treatment was switched owing to persisting symptoms , probably due to H. Influenzae infection in 3 cases . The patients ' own estimates of their symptoms suggested treatment with erythromycin to have a more rapid effect than treatment with penicillin Background : The aim of this study of 352 patients , 1–14 years of age , with acute respiratory infections and a history of recurrent respiratory tract infections ( RRTIs ) , and 208 healthy subjects was to evaluate whether Mycoplasma pneumoniae and Chlamydia pneumoniae played a role in causing acute respiratory episodes among children with RRTIs and whether specific antibiotic treatment for these bacteria could improve the acute episodes and reduce recurrences . Methods : The patients were blindly r and omized to receive azithromycin ( 10 mg/kg/d for 3 days weekly , for 3 weeks ) together with symptom-specific agents or symptom-specific agents alone . Acute M. pneumoniae and /or C. pneumoniae infection was diagnosed if the child had a significant antibody response in paired sera and /or if the DNA of the bacteria was detected in nasopharyngeal aspirates . Results : Atypical bacterial infections were identified for 190 patients ( 54.0 % ) and 8 healthy control subjects ( 3.8 % ; P < 0.0001 ) . Short term ( 1-month ) clinical success was significantly more frequent among the patients who had received azithromycin together with symptom-specific agents than among those who had received symptom-specific agents alone , but the difference was significant only for the group of patients with atypical bacteria . In contrast , long term ( 6-month ) clinical success was significantly more frequent among the patients who had received azithromycin in addition to symptom-specific agents , regardless of whether they experienced infections with atypical bacteria or other pathogens , although positive outcomes were significantly more frequent among those with atypical bacteria . Conclusions : Atypical bacteria seem to play a role among children with RRTIs , and prolonged azithromycin therapy can significantly improve the acute episodes and reduce the risk of recurrences BACKGROUND Clarithromycin is postulated to possess immunomodulatory properties in addition to its antimicrobial activity . OBJECTIVE To evaluate the effect of clarithromycin on serum and nasopharyngeal cytokine and chemokine concentrations in children with an acute exacerbation of recurrent wheezing . METHODS Children with a history of recurrent wheezing or asthma and who presented with an acute exacerbation of wheezing were enrolled in a double-blind , r and omized trial of clarithromycin vs placebo . Concentrations of tumor necrosis factor alpha ( TNF-alpha ) , interferon-gamma ( IFN-gamma ) , interleukin-1beta ( IL-1beta ) , IL-2 , IL-4 , IL-5 , IL-6 , IL-8 , IL-10 , granulocyte-macrophage colony-stimulating factor , RANTES , eotaxin , macrophage inflammatory protein 1alpha , macrophage inflammatory protein 1beta , and monocyte chemoattractant protein 1 were measured in serum and /or nasopharyngeal aspirates before , during , and after therapy . Mycoplasma pneumoniae and Chlamydophila pneumoniae infection were evaluated for by polymerase chain reaction and serologic testing . RESULTS Nasopharyngeal concentrations of TNF-alpha , IL-1beta , and IL-10 were significantly and persistently lower in children treated with clarithromycin compared with placebo . There tended to be a greater effect of clarithromycin on nasopharyngeal cytokine concentrations in patients with evidence of M. pneumoniae or C. pneumoniae infection . No significant differences were detected in serum cytokines for children treated with clarithromycin compared with placebo . CONCLUSION Clarithromycin therapy reduces mucosal TNF-alpha , IL-1beta , and IL-10 concentrations in children with an acute exacerbation of recurrent wheezing OBJECTIVES The precise epidemiology of childhood pneumonia remains poorly defined . Accurate and prompt etiologic diagnosis is limited by inadequate clinical , radiologic , and laboratory diagnostic methods . The objective of this study was to determine as precisely as possible the epidemiology and morbidity of community-acquired pneumonia in hospitalized children . METHODS Consecutive immunocompetent children hospitalized with radiographically confirmed lower respiratory infections ( LRIs ) were evaluated prospect ively from January 1999 through March 2000 . Positive blood or pleural fluid cultures or pneumolysin-based polymerase chain reaction assays , viral direct fluorescent antibody tests , or viral , mycoplasmal , or chlamydial serologic tests were considered indicative of infection by those organisms . Methods for diagnosis of pneumococcal pneumonia among study subjects were published by us previously . Selected clinical characteristics , indices of inflammation ( white blood cell and differential counts and procalcitonin values ) , and clinical outcome measures ( time to defervescence and duration of oxygen supplementation and hospitalization ) were compared among groups of children . RESULTS One hundred fifty-four hospitalized children with LRIs were enrolled . Median age was 33 months ( range : 2 months to 17 years ) . A pathogen was identified in 79 % of children . Typical respiratory bacteria were identified in 60 % ( of which 73 % were Streptococcus pneumoniae ) , viruses in 45 % , Mycoplasma pneumoniae in 14 % , Chlamydia pneumoniae in 9 % , and mixed bacterial/viral infections in 23 % . Preschool-aged children had as many episodes of atypical bacterial LRIs as older children . Children with typical bacterial or mixed bacterial/viral infections had the greatest inflammation and disease severity . Multivariate logistic-regression analyses revealed that high temperature ( > or = 38.4 degrees C ) within 72 hours after admission ( odds ratio : 2.2 ; 95 % confidence interval : 1.4 - 3.5 ) and the presence of pleural effusion ( odds ratio : 6.6 ; 95 % confidence interval : 2.1 - 21.2 ) were significantly associated with bacterial pneumonia . CONCLUSIONS This study used an exp and ed diagnostic armamentarium to define the broad spectrum of pathogens that cause pneumonia in hospitalized children . The data confirm the importance of S pneumoniae and the frequent occurrence of bacterial and viral coinfections in children with pneumonia . These findings will facilitate age-appropriate antibiotic selection and future evaluation of the clinical effectiveness of the pneumococcal conjugate vaccine as well as other c and i date vaccines BACKGROUND Studies of zinc as an adjunct to treatment of severe pneumonia in children have shown mixed results , possibly because of poor information on zinc status and respiratory pathogens . OBJECTIVE We evaluated the effect of zinc given with st and ard antimicrobial treatment on the duration of respiratory signs in children with severe pneumonia . Zinc status and pathogens were assessed . DESIGN Children aged 2 - 59 mo with severe pneumonia who were admitted to the main children 's hospital in Quito , Ecuador , were given st and ard antibiotics and r and omly allocated to receive zinc supplements twice daily or a placebo . Measurements included anthropometric variables , breastfeeding , hemoglobin , plasma zinc , and common bacteria/viral respiratory pathogens . The primary outcome was time to resolution of respiratory signs . The secondary outcome was treatment failure . RESULTS We enrolled 225 children in each group . There was no difference between groups in time to resolution of respiratory signs or treatment failure ; pathogens were not associated with outcomes . Tachypnea and hypoxemia resolved faster in older children ( P = 0.0001 ) than in younger ones . Higher basal zinc concentration ( P = 0.011 ) and better height-for-age z score ( HAZ ) ( P = 0.044 ) were associated with faster resolution of chest indrawing . Better weight-for-height z score ( WHZ ) ( P = 0.031 ) and HAZ ( P = 0.048 ) were associated with faster resolution of tachypnea . Increased C-reactive protein was associated with a longer duration of tachypnea ( P = 0.044 ) . CONCLUSIONS Zinc did not affect time to pneumonia resolution or treatment failure , nor did type of respiratory pathogens affect outcomes . Higher basal zinc and better HAZ and WHZ were associated with reduced time to resolution of respiratory signs . These results suggest the need for prevention of chronic zinc deficiency and improvement of general nutritional status among Ecuadorian children We evaluated 260 previously healthy children ages 3 through 12 years who had clinical signs and symptoms of pneumonia , radiographically confirmed . Patients were r and omized 1:1 to a 10-day course of either clarithromycin suspension 15 mg/kg/day divided twice a day or erythromycin suspension 40 mg/kg/day divided twice a day or three times a day . Evidence of infection with Chlamydia pneumoniae was detected in 28 % ( 74 ) of patients : 13 % ( 34 ) by nasopharyngeal culture and 18 % ( 48 ) by serology with the microimmunofluorescence assay . Evidence of infection with Mycoplasma pneumoniae was detected in 27 % ( 69 ) of patients : 20 % ( 53 ) by nasopharyngeal culture or polymerase chain reaction and 17 % ( 44 ) by serology with the use of enzyme-linked immunosorbent assay . Serologic confirmation of infection was observed in 23 % ( 8) and 53 % ( 28 ) of patients with bacteriologically detected C. pneumoniae and M. pneumoniae , respectively . Treatment with clarithromycin vs. erythromycin , respectively , yielded the following outcomes : clinical success 98 % ( 121 of 124 ) vs. 95 % ( 105 of 110 ) ; radiologic success 98 % ( 109 of 111 ) vs. 94 % ( 92 of 110 ) ; and eradication by pathogen , C. pneumoniae 79 % ( 15 of 19 ) vs. 86 % ( 12 of 14 ) and M. pneumoniae 100 % ( 9 of 9 ) vs. 100 % ( 4 of 4 ) . Adverse events were primarily gastrointestinal occurring in almost one-fourth of patients in both groups , and were mild to moderate in severity . Clarithromycin and erythromycin were similarly effective and safe for the treatment of radiographically proved , community-acquired pneumonia in children older than 2 years old . ( ABSTRACT TRUNCATED AT 250 WORDS The efficacy and tolerability of azithromycin and erythromycin in the treatment of acute respiratory tract infections in children were compared in an open , multicenter , r and omized trial . A total of 151 children , aged from 2 months to 14 years , suffering from upper airways infections ( 60 ) , or lower respiratory tract infections ( 91 ) , were r and omized to be treated either with azithromycin , 10 mg/Kg/day per os once daily for 3 or 10 mg/Kg/day 1 and 5 mg/Kg/days 2 - 5 ( 77 patients ) or with  erythromycin  , 50 mg/Kg/day  thrice daily  for at least 7 days ( 74 patients ) . The two treatment groups did not significantly differ as to sex , age , weight , type and severity of infection , and infecting pathogens . Clinical evaluation was performed prior to therapy , on treatment days  
    Output:
    
In most studies , clinical response did not differ between children r and omised to a macrolide antibiotic and children r and omised to a non-macrolide antibiotic .