***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 otitis media ( AOM ) is a common childhood illness and the leading indication for antibiotic prescriptions for US children . Xylitol , a naturally occurring sugar alcohol , can reduce AOM when given 5 times per day as a gum or syrup , but a more convenient dosing regimen is needed for widespread adoption . METHODS : We design ed a pragmatic practice -based r and omized controlled trial to determine if viscous xylitol solution at a dose of 5 g 3 times per day could reduce the occurrence of clinical ly diagnosed AOM among otitis-prone children 6 months through 5 years of age . RESULTS : A total of 326 subjects were enrolled , with 160 allocated to xylitol  and 166 to placebo .  In the primary analysis of time to first clinical ly diagnosed AOM episode , the hazard ratio for xylitol versus placebo recipients was 0.88 ( 95 % confidence interval [ CI ] 0.61 to 1.3 ) . In secondary analyses , the incidence of AOM was 0.53 episodes per 90 days in the xylitol group versus 0.59 in the placebo group ( difference 0.06 ; 95 % CI –0.25 to 0.13 ) ; total antibiotic use was 6.8 days per 90 days in the xylitol group versus 6.4 in the placebo group ( difference 0.4 ; 95 % CI –1.8 to 2.7 ) . The lack of effectiveness was not explained by nonadherence to treatment , as the hazard ratio for those taking nearly all assigned xylitol compared with those taking none was 0.93 ( 95 % CI 0.56 to 1.57 ) . CONCLUSIONS : Viscous xylitol solution in a dose of 5 g 3 times per day was ineffective in reducing clinical ly diagnosed AOM among otitis-prone children PURPOSE The aim of this study was to evaluate the lactic acid concentration in supragingival plaque from caries-active pre-school children after a short-term use of either xylitol- or sorbitol-containing chewing gums . MATERIAL AND METHODS The investigation consisted of a prospect i ve crossover design with 10 healthy children aged 2 - 4 years each with at least two caries lesions within the dentine ( ds > or = 2 ) . The children were instructed to chew 6 pieces of a test or a control gum every day for a 14-day period . The test gum contained 65 % xylitol and the control gum was sweetened with sorbitol . At baseline and after 14 days , salivary mutans streptococci were enumerated with a chair-side test ( Strip mutans ) and dental plaque was collected from the upper maxillary incisors . After a washout period of 6 weeks , the same procedure was repeated with the corresponding test or control gum . Lactic acid was determined enzymatically in glucose-challenged plaque suspensions . RESULTS The lactic acid concentration was significantly reduced ( p<0.05 ) by 22 % compared with baseline following the xylitol gum regimen but was unaltered after the control gum . The levels of salivary mutans streptococci were mainly unaffected by both chewing gums . CONCLUSION A 14-day use of xylitol-containing chewing gums , corresponding to a daily amount of 5 grams of xylitol , could diminish glucose-initiated lactic acid formation in supragingival plaque in caries-active pre-school children CONTEXT Adenoidectomy and adenotonsillectomy are commonly performed in US children to reduce the occurrence of persistent or recurrent otitis media , but evidence supporting the efficacy of the operations is limited . OBJECTIVES To test the efficacy of adenoidectomy and adenotonsillectomy in children with persistent or recurrent otitis media who had not previously undergone tube placement and to compare the relative efficacy of adenoidectomy alone vs adenotonsillectomy in such children . DESIGN Two parallel r and omized clinical trials . SETTING AND PARTICIPANTS A total of 461 children aged 3 to 15 years were enrolled at Children 's Hospital of Pittsburgh , Pa , between April 1980 and April 1994 . Four hundred ten children were observed for up to 3 years . INTERVENTIONS Children without recurrent throat infection or tonsillar hypertrophy ( 304 enrolled ; 266 followed up ) were r and omized to either an adenoidectomy , adenotonsillectomy , or control group ;  children who had such conditions ( 157 enrolled ; 144 followed up ) were r and omized to an adenotonsillectomy or control group . MAIN OUTCOME MEASURES Occurrence rate of episodes of acute otitis media by treatment group and estimated proportion of time with otitis media . RESULTS In both trials , most subjects were eligible because of recurrent acute otitis media , with or without persistent otitis media with effusion .  A total of 47 children assigned to surgical treatment groups had no surgery . The efficacy of surgery in both trials was modest and limited mainly to the first follow-up year . The largest differences in that year were found in the 3-way trial between the adenotonsillectomy group and the control group : mean annual rate of episodes of acute otitis media , 1.4 vs 2.1 ( P<.001 ) ; and mean estimated percentage of time with otitis media , 18.6 % vs 29.9 % ( difference , 11.3 % ; 95 % confidence interval , 4.4%-18.2 % ; P=.002 ) . Perioperative and postoperative complications or other adverse events occurred not infrequently , especially among subjects undergoing adenotonsillectomy ( 14.6 % ) . CONCLUSIONS Our study showed limited and short-term efficacy of both adenoidectomy and adenotonsillectomy ; given the risks , morbidity , and costs of these procedures , these data suggest that neither operation should ordinarily be considered as a first surgical intervention in children whose only indication is recurrent acute otitis media Abstract Objective : To examine whether xylitol , which reduces the growth of Streptococcus pneumoniae , might have clinical importance in the prevention of acute otitis media . Design : A double blind r and omised trial with xylitol administered in chewing gum . Setting : Eleven day care nurseries in the city of Oulu . Most of the children had had problems with recurrent acute otitis media . Subjects : 306 day care children : 149 children in the sucrose group ( 76 boys ; mean ( SD ) age 4.9 ( 1.5 ) years ) and 157 in the xylitol group ( 80 boys ; 5.0 ( 1.4 ) years ) . Intervention : Either xylitol ( 8.4 g a day ) or sucrose ( control ) chewing gum for two months . Main outcome measures : The occurrence of acute otitis media and antimicrobial treatment received during the intervention and nasopharyngeal carriage of S pneumoniae . Results : During the two month monitoring period at least one event of acute otitis media was experienced by 31/149 ( 20.8 % ) children who received sucrose compared with 19/157 ( 12.1 % ) of those receiving chewing gum containing xylitol ( difference 8.7 % ; 95 % confidence interval 0.4 % to 17.0 % ; P = 0.04 ) . Significantly fewer antimicrobials were prescribed among those receiving xylitol : 29/157 ( 18.5 % ) children had at least one period of treatment versus 43/149 ( 28.9 % ) ( difference 10.4 % ; 0.9 % to 19.9 % ; P = 0.032 ) . The carriage rate of S pneumoniae varied from 17.4 % to 28.2 % with no difference between the groups . Two children in the xylitol group experienced diarrhoea , but no other adverse effects were noted among the xylitol users . Conclusion : Xylitol seems to have a preventive effect against acute otitis media . Key messages It also inhibits the growth of S pneumoniae When given to children with recurrent otitis mediain chewing gum xylitol reduced the occurrence of otitis media by about 40 % The daily dose required is not known , but 8.4 g given daily in a chewing gum seems to be effective Xylitol had no effect on the nasopharyngeal car- riage of OBJECTIVES To evaluate the effectiveness of a xylitol pediatric topical oral syrup to reduce the incidence of dental caries among very young children and to evaluate the effect of xylitol in reducing acute otitis media in a subsequent study . DESIGN Double-blind r and omized controlled trial . SETTING Communities in the Republic of the Marshall Isl and s. PARTICIPANTS One hundred eight children aged 9 to 15 months were screened , and 100 were enrolled . Intervention Children were r and omized to receive xylitol topical oral syrup ( administered by their parents ) twice a day ( 2 xylitol [ 4.00-g ] doses and 1 sorbitol dose ) ( Xyl-2 x group ) or thrice per day ( 3 xylitol [ 2.67-g ] doses ) ( Xyl-3x group ) vs a control syrup ( 1 xylitol [ 2.67-g ] dose and 2 sorbitol doses ) ( control group ) . MAIN OUTCOME MEASURES The primary outcome end point of the study was the number of decayed primary teeth . A secondary outcome end point was the incidence of acute otitis media for reporting in a subsequent report . RESULTS Ninety-four children ( mean [ SD ] age , 15.0 [ 2.7 ] months at r and omization ) with at least 1 follow-up examination were included in the intent-to-treat analysis . The mean ( SD ) follow-up period was 10.5 ( 2.2 ) months . Fifteen of 29 of the children in the control group ( 51.7 % ) had tooth decay compared with 13 of 32 children in the Xyl-3x group ( 40.6 % ) and eight of 33 children in the Xyl-2x group ( 24.2 % ) . The mean ( SD ) numbers of decayed teeth were 1.9 ( 2.4 ) in the control group , 1.0 ( 1.4 ) in the Xyl-3x group , and 0.6 ( 1.1 ) in the Xyl-2x group . Compared with the control group , there were significantly fewer decayed teeth in the Xyl-2x group ( relative risk , 0.30 ; 95 % confidence interval , 0.13 - 0.66 ; P = .003 ) and in the Xyl-3x group ( 0.50 ; 0.26 - 0.96 ; P = .04 ) . No statistical difference was noted between the 2 xylitol treatment groups ( P = .22 ) . CONCLUSION Xylitol oral syrup administered topically 2 or 3 times daily at a total daily dose of 8 g was effective in preventing early childhood caries BACKGROUND The decision to seek medical advise for  children during upper respiratory infections is largely based on the parental assumption that the child 's symptoms are related to acute otitis media . The symptoms related to acute otitis media , however , are considered nonspecific . METHODS Altogether 857 healthy day-care children ( mean age , 3.7 years ) were followed up for 3 months , and the symptoms of each child were compared during upper respiratory infections with and without acute otitis media . RESULTS A total of 138 children had upper respiratory infections with and without acute otitis media . The symptom with the strongest association with acute otitis media was earache [ relative risk ( RR ) , 21.3 ; 95 % confidence intervals ( CI ) , 7.0 to 106 , P < 0.0001 ] but sore throat ( RR = 3.2 ; CI = 1.1 to 11 ; P = 0.027 ) , night restlessness ( RR = 2.6 ; CI = 1.1 to 6.9 ; P = 0.024 ) and fever ( RR = 1.8 ; CI = 1.1 to 3.2 ; P = 0.025 ) also had significant associations . Logistic regression analysis showed 71 % of the cases to be correctly diagnosed on the basis of the symptoms of earache and night restlessness . The parents were able to predict the presence of acute otitis media with a sensitivity and specificity of 71 and 80 % , respectively ( positive predictive value , 51 % ; negative predictive value , 90 % ) . CONCLUSIONS Despite the limited value of symptoms in differentiating acute otitis media from upper respiratory infection , the parents are able to predict acute otitis media somewhat reliably . More symptoms than have been reported earlier appeared to be associated with acute otitis media OBJECTIVE Xylitol , given as 2 g orally five times-a-day , significantly reduces the incidence of acute otitis media ( AOM ) in children . A less frequent dosing schedule , if tolerable and efficacious , would promote the more widespread use of this treatment . We sought to determine the tolerability and acceptability in young children of oral xylitol solution at doses of 5 g three times-a-day ( TID ) and 7.5 g once daily ( QD ) . METHODS The study was a 3-month r and omized placebo-controlled trial of the tolerability and acceptability of oral xylitol solution in 120 
    Output:
    
There is moderate quality evidence showing that the prophylactic administration of xylitol among healthy children attending daycare centres can reduce the occurrence of AOM .
There is inconclusive evidence with regard to the efficacy of xylitol in preventing AOM among children with respiratory infection , or among otitis-prone children .