***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: Efficacy and safety of a new oral third generation Cephalosporin , Cefotiam Hexetil ( CTM ) 200 mg bid were compared with those of Cefixime ( CX ) 200 mg bid over 10 day duration of treatment . One hundred and twenty two ambulatory adults suffering from chronic sinusitis were r and omized by ENT specialists in this multicentre prospect i ve double blind , doubled dummy study . Sinusitis diagnosis evocated in front of fascial pain , purulent nasal discharge and /or obstruction was confirmed with sinus X-ray . Use of antibiotics or corticosteroids concomitantly or 15 days prior inclusion represented one of the major exclusion criterion . One hundred and seventy one patients were evaluated for efficacy analysis ( 62 and 59 respectively in CTM and CX groups ) . Regarding demographic data , clinical and radiological signs , the two population s were comparable at inclusion excepted for sex and weight ( female : 73 % in  CTM group versus 47 % in  CX group ) . The overall clinical success rate at the end of treatment ( cure+improvement ) was not significantly different between the two groups ( CTM : 82 % versus CX : 80 % ) . The incidence of adverse events was less frequent in the CTM group ( 14.5 % versus 19 % ) . In conclusion , CTM 200 mg bid is as efficacious and as well tolerated as CX 200 mg bid in the treatment of chronic sinusitis in adults BACKGROUND There is little scientific evidence to support the current practice of using oral glucocorticosteroids and antibiotics to treat patients with chronic rhinosinusitis and nasal polyps . OBJECTIVE We evaluated the effects of oral glucocorticoids and doxycycline on symptoms and objective clinical and biological parameters in patients with chronic rhinosinusitis and nasal polyps . METHODS In a double-blind , placebo-controlled , multicenter trial , we r and omly assigned 47 participants with bilateral nasal polyps to receive either methylprednisolone in decreasing doses ( 32 - 8 mg once daily ) , doxycycline ( 200 mg on the first day , followed by 100 mg once daily ) , or placebo for 20 days . Participants were followed for 12 weeks . Patients were assessed for nasal peak inspiratory flow and symptoms and by nasal endoscopy . Markers of inflammation such as eosinophilic cationic protein ( ECP ) , IL-5 , myeloperoxidase , matrix metalloproteinase 9 , and IgE were measured in nasal secretions . Concentrations of eosinophils , ECP , and soluble IL-5 receptor alpha were measured in peripheral blood sample s. RESULTS Methylprednisolone and doxycycline each significantly decreased nasal polyp size compared with placebo . The effect of methylprednisolone was maximal at week 3 and lasted until week 8 , whereas the effect of doxycycline was moderate but present for 12 weeks . Methylprednisolone significantly reduced levels of ECP , IL-5 , and IgE in nasal secretions , whereas doxycycline significantly reduced levels of myeloperoxidase , ECP , and matrix metalloproteinase 9 in nasal secretions . CONCLUSION This is the first double-blind , placebo-controlled study to show a significant effect of oral methylprednisolone and doxycycline on size of nasal polyps , nasal symptoms , and mucosal and systemic markers of inflammation It has been established that long-term low-dose erythromycin therapy ( EM therapy ) is very effective for sinobronchial syndrome , a common condition in Japan characterized by chronic upper and lower airway inflammation . The effect does not result from its bacteriocidal activity and the detailed mechanisms are not known . It takes 3 - 6 months for EM therapy to improve the symptoms . This study was design ed to evaluate the additive effect of continuous low dosage or intermittent usual dosage of ofloxacin ( OFLX ) on EM therapy in patients with sinobronchial syndrome . Patients with sinobronchial syndrome were r and omly allocated to receive one of the following four regimens . Patients in Group A received both low-dose OFLX and EM therapy daily for 6 months . Patients in Group B received EM therapy and intermittent treatment of OFLX for 6 months . Patients in Group C underwent EM therapy for 6 months . Patients in Group D received neither OFLX nor EM therapy . All patients were given carbocystein for more than 2 months before starting each treatment and during the study period . In patients receiving OFLX and /or EM therapy , these antimicrobial agents were well-tolerated during the treatment period . Amount of sputum in the morning was significantly less in Group C than in Group D after 3 - 6 months , and decreased significantly in Group A as compared with Group B after 2 weeks , Group C after 2 weeks to 2 months , and Group D after 2 weeks to 6 months . Other symptoms such as number of expectorations , difficulty of expectoration and severity of cough also improved rapidly in Group A. These findings suggest that it is useful to add low-dose OFLX to EM therapy for sinobronchial syndrome , especially within 1 - 2 months from starting treatment , and it may be cost-effective as this combination therapy can shorten the treatment period of EM therapy In recent years quality of life instruments have been featured as primary outcomes in many r and omized trials . One of the challenges facing the investigator using such measures is determining the significance of any differences observed , and communicating that significance to clinicians who will be applying the trial results . We have developed an approach to elucidating the significance of changes in score in quality of life instruments by comparing them to global ratings of change . Using this approach we have established a plausible range within which the minimal clinical ly important difference ( MCID ) falls . In three studies in which instruments measuring  dyspnea , fatigue , and emotional function in patients with chronic heart and lung disease were applied the MCID was represented by mean change in score of approximately 0.5 per item , when responses were presented on a seven point Likert scale . Furthermore , we have established ranges for changes in question naire scores that correspond to moderate and large changes in the domains of interest . This information will be useful in interpreting question naire scores , both in individuals and in groups of patients participating in controlled trials , and in the planning of new trials In the present study 141 children aged between 3 and 10 years and suffering from chronic maxillary sinusitis were treated non-selectively in one of 4 ways : amoxicillin combined with decongestive nose drops , drainage of the maxillary sinus , a combination of the two , or a placebo . The duration of the follow-up period was 6 months . The therapeutic effects of the 4 forms of treatment did not differ significantly . Haemophilus influenzae and streptococcus pneumoniae were the micro-organisms encountered most often in these children . The results are discussed BACKGROUND The treatment of acute , recurrent , and chronic sinusitis remains controversial because of the presence of a wide variety of aerobic and anaerobic bacteria in the sinuses . DESIGN This double-blind , r and omized trial compared cefaclor with amoxicillin in the treatment of acute , recurrent , and chronic maxillary sinusitis using clinical evaluation , roentgenography , and microbiologic evaluation of antral aspirates . SETTING Outpatient office of five otorhinolaryngologists in Salt Lake City , Utah . PATIENTS One hundred eight adult patients with acute , recurrent , or chronic maxillary sinusitis . INTERVENTION Oral treatment with cefaclor ( 500 mg ) twice daily or amoxicillin ( 500 mg ) three times daily for 10 days . MAIN OUTCOME MEASURE Clinical response to treatment with cefaclor vs amoxicillin . RESULTS Fifty-six patients with acute sinusitis , 25 with recurrent sinusitis , and 15 with chronic sinusitis were evaluable . Although multiple organisms were common in each group , patients with acute sinusitis were more likely to have Haemophilus influenzae or Streptococcus pneumoniae , and patients with recurrent or chronic sinusitis were more likely to have anaerobes in sinus aspirate . Whether treated with cefaclor or amoxicillin , clinical improvement occurred in 86 % of patients with acute sinusitis and 56 % of patients with recurrent sinusitis . Patients with chronic sinusitis were too few to allow statistical analysis of the differences in outcome between them and patients with recurrent or acute sinusitis . Resistance of the cultured organisms to the study drug used was unrelated to treatment outcome . CONCLUSIONS The rate of clinical improvement was high in patients with acute sinusitis but was less favorable in those with recurrent and chronic disease regardless of the study drug used . The susceptibility of organisms isolated to the study drugs was unrelated to outcome OBJECTIVES To conduct the first prospect i ve r and omized controlled trial , evaluating and comparing the effect of medical and surgical treatment of chronic rhinosinusitis ( CRS ) on quality of life . MATERIAL S AND METHODS Ninety patients with CRS , who remained symptomatic after initial medical treatment with Dexarhinaspray duo and nasal douche , were r and omized either to medical or surgical therapy .  All patients underwent pre- and post-treatment assessment s of the Sinonasal Outcome Test-20 ( SNOT-20 ) , and the Short Form 36 Health Survey ( SF-36 ) . Each patient had three assessment s : before starting the r and omized treatment , after six months and finally after one year . RESULTS Both the medical and surgical treatment of CRS significantly improved almost all the parameters of SNOT and SF-36 ( p<0.05 ) , with no significant difference being found between the medical and surgical groups ( p>0.05 ) . CONCLUSION Both maximal medical and surgical therapy of CRS improves the quality of life of CRS patients , providing further evidence that chronic rhinosinusitis should be targeted with maximal medical therapy in the first instance , with surgical treatment being reserved for cases refractory to medical therapy . The presence of nasal polyps does not imply any negative effect on the quality of life after CRS therapy , either medical or surgical This study was performed to investigate the course of spontaneous recovery from otitis media with effusion in children with chronic rhinosinusitis treated in various ways . One hundred forty-one children between 3 and 10 years of age were selected for the presence of chronic rhinosinusitis and unilateral or bilateral otitis media with effusion . The children were assigned at r and om to one of four treatment groups , i.e. , placebo , amoxicillin combined with xylometazoline hydrochloride nose drops , maxillary sinus drainage , or a combination of the latter two forms of therapy . The follow-up period was 6 months . Drainage of the maxillary sinus had no effect on either the recovery of the chronic upper respiratory tract infection or otitis media with effusion . Amoxicillin combined with xylometazoline nose drops had no significant effect on recovery from the upper respiratory tract infection , but did have a small but significant effect on recovery from otitis media with effusion . However , the general tendency of the upper respiratory tract and ears to recover was poor . Persistence of the chronic upper respiratory tract infection during the follow-up period proved to be a negative prognostic factor with respect to cure of otitis media with effusion .  Children with chronic rhinosinusitis as defined in this study appear to have a high risk of developing chronic otitis media with effusion . The results of the study are discussed The objective of the study was to reveal if mometasone furoate nasal spray as monotherapy or combined with long-term oral clarithromycin have influence on biofilms in chronic rhinosinusitis with polyps . The study is a r and omized controlled trial in a tertiary referral hospital . Thirty-four patients with chronic rhinosinusitis completed the study . In the first group , 19 patients received mometasone furoate nasal spray 200 μg once daily for 8 weeks . In the second group , 15 patients received oral clarithromycin 500 mg twice daily for 2 weeks and continued once daily 250 mg tablet for subsequent 6 weeks , plus mometasone furoate . Scanning electron microscopy was the primary outcome measure . Secondary outcome measures included computerized tomography and sinonasal outcome test-20 items . Mucosal biofilms were detected in 23 of 34 ( 68 % ) patients on pretreatment polyp sample s. After the treatment , biofilms disappeared in 1 of 11 patients in the first group , whereas the eradication of biofilms was evident in 6 of 12 ( 50 % ) patients in the second group . Tomography scores improved in eight patients of each group ( 42.1 and 53.4 % , respectively ) . The comparison of improvements did not reveal significant difference between the groups . The overall symptom scores improved compared to the baseline levels . The mean changes of −8.8421 and −11.4000 in the first and second group , respectively , were not statistically different . Adding long-term low-dose oral macrolides to nasal steroids was effective in the eradication of biofilm . However , we were not able to demonstrate that combined therapy was superior in terms of the improvement in tomography and symptom scores The bacteriology of chronic sinusitis was studied after amoxicillin-clavulanate potassium therapy .  Patients with chronic sinusitis were r and omly divided into 2 groups . In the study group , 90 patients were given a 2-week course of amoxicillin-clavulanate potassium  before functional endoscopic sinus surgery . In the control group , 113 patients did not take any antibiotics within 2 
    Output:
    
We found very little evidence that systemic antibiotics are effective in patients with chronic rhinosinusitis .