***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 Cough is the most common symptom presenting to doctors . The quality of cough ( productive or wet vs dry ) is used clinical ly as well as in epidemiology and clinical research . There is however no data on the validity of cough quality descriptors . The study aims were to compare ( 1 ) cough quality ( wet/dry and brassy/non-brassy ) to bronchoscopic findings of secretions and tracheomalacia respectively and , ( 2 ) parent 's vs clinician 's evaluation of the cough quality ( wet/dry ) . Methods Cough quality of children ( without a known underlying respiratory disease ) undergoing elective bronchoscopy  was independently evaluated by clinicians and parents . A ' blinded ' clinician scored the secretions seen at bronchoscopy on pre-determined criteria and grade d ( 1 to 6 ) . Kappa ( K ) statistics was used for agreement , and inter-rater and intra-rater agreement examined on digitally recorded cough . A receiver operating characteristic ( ROC ) curve was used to determine if cough quality related to amount of airway secretions present at bronchoscopy . Results Median age of the 106 children ( 62 boys , 44 girls ) enrolled was 2.6 years ( IQR 5.7 ) . Parent 's assessment of cough quality ( wet/dry ) agreed with clinicians ' ( K = 0.75 , 95%CI 0.58–0.93 ) . When compared to bronchoscopy ( bronchoscopic secretion grade 4 ) , clinicians ' cough assessment had the highest sensitivity ( 0.75 ) and specificity ( 0.79 ) and were marginally better than parent(s ) . The area under the ROC curve was 0.85 ( 95%CI 0.77–0.92 ) . Intra-observer ( K = 1.0 ) and inter-clinician agreement for wet/dry cough ( K = 0.88 , 95%CI 0.82–0.94 ) was very good . Weighted K for inter-rater agreement for bronchoscopic secretion grade s was 0.95 ( 95%CI 0.87–1 ) . Sensitivity and specificity for brassy cough ( for tracheomalacia ) were 0.57 and 0.81 respectively . K for both intra and inter-observer clinician agreement for brassy cough was 0.79 ( 95%CI 0.73–0.86 ) . Conclusions Dry and wet cough in children , as determined by clinicians and parents has good clinical validity . Clinicians should however be cognisant that children with dry cough may have minimal to mild airway secretions . Brassy cough determined by respiratory physicians is highly specific for tracheomalacia A successful , systematic , anatomic , diagnostic protocol for evaluating patients with chronic cough  was presented in 1981 . To determine whether it was still valid , we prospect ively evaluated , over a 22-month interval , 102 consecutive and unselected immunocompetent patients complaining of cough an average of 53 + /- 97 months ( range , 3 wk to 50 yr ) . Utilizing the anatomic , diagnostic protocol modified to include prolonged esophageal pH monitoring ( EPM ) , the causes of cough were determined in 101 of 102 ( 99 % ) patients , leading to specific therapy that was successful in 98 % . Cough was due to one condition in 73 % , two in 23 % , and three in 3 % . Postnasal drip syndrome was a cause 41 % of the time , asthma 24 % , gastroesophageal reflux ( GER ) 21 % , chronic bronchitis 5 % , bronchiectasis 4 % , and miscellaneous conditions 5 % . Cough was the sole presenting manifestation of asthma and GER 28 and 43 % of the time , respectively . While history , physical examination , methacholine inhalational challenge ( MIC ) , and EPM yielded the most frequent true positive results , MIC was falsely positive 22 % of the time in predicting that asthma was the cause of cough . Laboratory testing was particularly useful in ruling out suspected possibilities . We conclude that the anatomic diagnostic protocol is still valid and that it has well-defined strengths and limitations 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 A double-blind r and omized controlled trial of amoxycillin , co-trimoxazole , and placebo was conducted on 197 children presenting with presumed viral respiratory infections . Routine throat swabs were taken to exclude streptococcal diseases . The three disease categories studied -- nasopharyngitis , pharyngotonsillitis , and bronchitis ( including laryngotracheobronchitis)--showed a generally similar pattern of resolution irrespective of treatment . Nevertheless , seven out of 66 children receiving placebo were withdrawn from the trial with unremitting symptoms or complications thought to require antimicrobial treatment . Only two of 56 children receiving amoxycillin and none of 75 receiving co-trimoxazole were withdrawn . Three other children receiving amoxycillin and three receiving placebo were seen during the trial but further treatment was not thought to be necessary . Thus the return consultation rate in children receiving placebo therapy was 15 % compared with 4 % for those receiving antimicrobial treatment . Antimicrobial treatment was associated with less nasal discharge on the eighth day of treatment . Placebo treatment allowed an earlier return to normal activity . There was a high incidence of possible side effects on all regimens including placebo . It is concluded that the benefits of antimicrobial treatment in presumed viral respiratory infections are marginal , and they should not be routinely prescribed for these conditions BACKGROUND & OBJECTIVES Information on oropharyngeal carriage rates of Streptococcus pneumoniae , Haemophilus influenzae , Streptococcus pyogenes and Moraxella catarrhalis and their resistance pattern in healthy school children in Turkey is lacking . The present study was undertaken to determine the carriage rates and antimicrobial resistance of these bacterial pathogens in such children aged 6 - 14 yr in Manisa , Turkey . METHODS A total of 1022 children were included from nine schools selected r and omly from 32 schools . Throat swabs were cultured for bacteria which were identified using st and ard microbiological methods . Antimicrobial susceptibility was determined as per National Committee for Clinical Laboratory St and ards guidelines . RESULTS Of the 1022 children 240 ( 23.4 % ) harboured S. pneumoniae , 162 ( 15.8 % ) H. influenzae , 30 ( 2.9 % ) S. pyogenes and 82 ( 8 % ) M. catarrhalis in their oropharynx . For S. pneumoniae overall 17.9 per cent of the isolates were intermediately and 7 per cent were resistant to penicillin and resistance to erythromycin trimethoprim-sulphamethoxasole ( TMP/SMX ) , and chloramphenicol was 13.7 , 9.1 and 1.6 per cent , respectively . Ampicillin resistance observed in 20.9 per cent of H. influenzae isolates was associated with the presence of beta-lactamase , except two isolates interpreted as beta-lactamase-negative ampicillin resistant strains . Resistance of H. influenzae to  TMP/SMX , chloramphenicol , azithromycin , cefaclor and amoxicillin/clavulanic acid  was 14.2 , 2.4 , 1.8 , 1.2 and 1.2 per cent , respectively . M.catarrhalis isolates produced beta-lactamase in 80.5 per cent of the cases and all were susceptible to macrolides and clavulanic acid/amoxicillin combination ; the highest rate of resistance of 17 per cent was for TMP/SMX . One ( 3.3 % ) isolate of S. pyogenes was resistant to macrolides tested . INTERPRETATION & CONCLUSION Our data shows that upper respiratory tract of about 50 per cent children was colonized with respiratory pathogens . There is a need for surveillance of nasopharyngeal carriage of resistant strains in healthy school children The benefits of antibiotic treatment and a nasopharyngeal culture in children with longst and ing cough were analysed in a prospect i ve r and omized open study . Clinical ly suspected pertussis was excluded . Of 40 children given erythromycin for 7 days , 35 ( 88 % ) recovered in one week , compared with 17/47 ( 36 % ) untreated ( p < 0.0001 ) . Erythromycin  eliminated Moraxella catarrhalis from the nasopharynx in 21/31 children ( 68 % ) , compared with spontaneous disappearance in 7/35 ( 20 % ) untreated controls ( p < 0.001 ) . Purulent bronchitis or otitis media occurred in 2 children ( 5 % ) in the treatment group and in 21 ( 45 % ) in the control group ( p < 0.01 ) . To evaluate the clinical role of isolated pathogens , the 47 untreated subjects were studied . Seven of 35 children harbouring M. catarrhalis recovered , compared with 8/12 in whom this bacterium was absent ( p < 0.01 ) . No correlation was found between the isolation of Haemophilus influenzae or Streptococcus pneumoniae and the clinical outcome .  Children with persistent cough  > 10 days may benefit from erythromycin treatment . M. catarrhalis in the nasopharynx indicates prolonged symptoms and increased risk of bacterial complications OBJECTIVE To evaluate the use of an adult-based algorithmic approach to chronic cough in a cohort of children with a history of > 3 weeks of cough and to describe the etiology of chronic cough in this cohort . METHODS A prospect i ve cohort study of children referred to a tertiary hospital with a history of > 3 weeks of cough between June 2002 and June 2004 . All included children followed a pathway of investigation ( including flexible bronchoscopy and evaluation of airway cytology via BAL ) until diagnosis was made and /or their cough resolved . RESULTS In our cohort of 108 young children ( median age 2.6 years ) , the majority had wet cough ( n = 96 ; 89 % ) , and BAL fluid sample s obtained during bronchoscopy led to a diagnosis in 45.4 % ( n = 49 ) . The most common final diagnosis was protracted bacterial bronchitis ( n = 43 ; 39.8 % ) . These patients had neutrophil levels on BAL sample s that were significantly higher than those in other diagnostic groups ( p < 0.0001 ) . Asthma , gastroesophageal reflux disease ( GERD ) , and upper airway cough syndrome ( UACS ) , which are common causes of chronic cough in adults , were found in < 10 % of the cohort ( n = 10 ) . CONCLUSIONS The adult-based anatomic pathway , which involves the investigation and treatment of patients with asthma , GERD , and UACS first is largely unsuitable for use in the management of chronic cough in young children as the common etiologies of chronic cough in children are different from those in adults This study compared the relative effectiveness of two antimicrobial preparations , amoxicillin and amoxicillin-clavulanate potassium ( Augmentin ) , in the treatment of acute maxillary sinusitis in children 2 to 16 years of age . Of 171 children with persistent ( ten to 30 days ' duration ) nasal discharge or daytime cough or both , 136 ( 80 % ) had abnormal maxillary sinus radiographs . These children were stratified by age and severity of symptoms and r and omly assigned to receive either amoxicillin , amoxicillin-clavulanate potassium , or placebo . After the exclusion of 28 children with throat cultures positive for group A Streptococcus and 15 who did not complete their medication , the remaining 93 children were evaluated : 30 received amoxicillin , 28 received amoxicillin-clavulanate potassium , and 35 received placebo .  Clinical assessment was performed at three and ten days . On each occasion , children treated with an antibiotic were more likely to be cured than children receiving placebo ( P less than .01 at three days , P less than 
    Output:
    
However for this outcome measure , the overall estimate of effect and degree of statistical heterogeneity were sensitive to the model used for meta- analysis .
Antibiotics are likely to be beneficial in the treatment of children with chronic moist cough .