***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: 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 In response to the dramatic emergence of resistant pneumococci , more judicious use of antibiotics has been advocated . Physician beliefs , their prescribing practice s , and the attitudes of patients have been evaluated previously in separate studies . METHODS This 3-part study included a statewide mailed survey , office chart review s , and parent telephone interviews . We compared survey responses of 366 licensed pediatricians and family physicians in Georgia to recently published recommendations on diagnosis and treatment of upper respiratory infections ( URIs ) . We further evaluated 25 r and omly selected pediatricians from 119 surveyed in the Atlanta metropolitan area . For each , charts from the first 30 patients between the ages of 12 and 72 months seen on a r and omly selected date were review ed for encounters during the preceding year . A sample of parents from each practice were interviewed by telephone . RESULTS In the survey , physicians agreed that overuse of antibiotics is a major factor contributing to the development of antibiotic resistance ( 97 % ) , and that they should consider selective pressure for resistance in their decisions on providing antibiotic treatment for URIs in children in their practice s ( 83 % ) . However , many reported practice s do not conform to the recently published principles for judicious antibiotic use . For example , 69 % of physicians considered purulent rhinitis a diagnostic finding for sinusitis ; 86 % prescribed antibiotics for bronchitis regardless of the duration of cough ; and 42 % prescribed antibiotics for the common cold . Reported practice s by family physicians were more often at odds with the published principles : they were significantly more likely than pediatricians to omit pneumatic otoscopy ( 46 % vs 25 % ) ; to omit the requirement for prolonged symptoms to diagnose sinusitis ( median 4 vs 10 days ) ; and to omit laboratory testing for pharyngitis ( 27 % vs 14 % ) . Of the 7531 encounters analyzed in the chart review , 43 % result ed in an antibiotic prescription , including 11 % of checkups , 18 % of telephone calls , and 72 % of visits for URIs . There was wide variability in the overall antibiotic use rates among the 25 physicians ( 1 - 10 courses per child per year ) . There was an even wider variability in some diagnosis-specific rates ; bronchitis and sinusitis in particular . Those with the highest antibiotic prescribing rates had up to 30 % more return office visits . Physicians who prescribed antibiotics for purulent rhinitis were more likely to see parents who believed that their children should be evaluated for cold symptoms . CONCLUSIONS Physicians recognize the problem of antibiotic resistance but their reported practice s are not in line with recently published recommendations for most pediatric URIs . The actual prescribing practice s of pediatricians are often considerably different from their close colleagues . Patient beliefs are correlated with their own physician 's practice 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 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 Purulent  nasal discharge  ( discharge that is thick , opaque and colored ) is a common clinical symptom in pediatrie patients . Although it may occur at any age it is probably most problematic and most common in children between birth and 2 to 3 years of age . This article review s the differential diagnosis , evaluation and management of purulent nasal discharge in children Objective . Although antimicrobial treatment for children with acute sinusitis is used commonly , it is unclear whether it offers significant clinical benefit . The purpose of this study was to evaluate the effectiveness of antimicrobial treatments for acute sinusitis as they are used in community pediatric practice . Methods . We conducted a r and omized , placebo-controlled trial in 3 community pediatric practice s in St Louis , Missouri . A total of 188 patients who were between the ages of 1 and 18 years and who had had 10 to 28 days of persistent sinus symptoms and a clinical diagnosis of acute sinusitis were r and omized to receive 14 days of amoxicillin ( 40 mg/kg/d in 3 daily doses ) , amoxicillin-clavulanate ( amoxicillin 45 mg/kg/d in 2 daily doses ) , or placebo .  Change in sinus symptoms was assessed both by a quantitative symptom score ( the S5 score ) and subjectively by the parent . Secondary outcomes included adverse effects of treatment and recurrence or relapse of sinus symptoms . Outcomes were assessed by telephone interviews over a 2-month period . Results . Of the 161 patients who were included in the analysis , 58 received amoxicillin , 48 received amoxicillin-clavulanate , and 55 received placebo . Day 14 improvement rates were 79 % , 81 % , and 79 % , respectively . There were no differences in the 14-day change in S5 score among treatment groups . The rates of adverse events ( amoxicillin , 19 % ; amoxicillin-clavulanate , 11 % ; placebo , 10 % ) , relapse ( amoxicillin , 12 % ; amoxicillin-clavulanate , 13 % ; placebo , 13 % ) , and recurrence ( amoxicillin , 9 % ; amoxicillin-clavulanate , 13 % ; placebo , 13 % ) of sinus symptoms were similar among treatment groups . Conclusion . Neither amoxicillin nor amoxicillin-clavulanate offered any clinical benefit compared with placebo for children with clinical ly diagnosed acute sinusitis We evaluated the role of antimicrobials in the treatment of  chronic maxillary sinusitis in children with respiratory allergy . Night and day cough , nasal obstruction , rhinorrhea , postnasal seen . Eighty-four children were treated in a double-blind manner with either amoxicillin , erythromycin , trimethoprim-sulfamethoxazole , or an antihistamine decongestant ( carbinoxamine maleate-pseudoephedrine HCl ) . Radiographic and clinical responses were best with amoxicillin , but trimethoprim-sulfamethoxazole was an adequate alternative . This study demonstrates that allergic children with chronic sinusitis with associated chronic respiratory symptoms are likely to respond clinical ly and radiologically with antimicrobial treatment Background : The purpose of our study was to examine how physicians diagnose sinusitis in practice . We addressed three specific questions : ( 1 ) what clinical factors do physicians look for in evaluating and caring for patients with suspected sinusitis , ( 2 ) to what extent do physicians use transillumination and radiograph evaluations in diagnosing sinusitis , and ( 3 ) how does the diagnosis of sinusitis influence the decision to prescribe antibiotic therapy ? Methods : We conducted a retrospective review using charts from 25 local family physicians who volunteered to participate in the study . After selecting a r and om sample of charts of adult patients treated for sinusitis and for upper respiratory tract infection ( URI ) by each physician , we review ed the charts to determine the nature of the information collected to differentiate between sinusitis and URI . Results : Rhinorrhea , sinus tenderness , visualization of purulent secretions , and a history of sinusitis were significant predictors of the diagnosis of sinusitis . Antibiotics were prescribed for 98.4 % of patients with sinusitis and 13.1 % of patients with URI . Conclusions : This sample of physicians based the diagnosis of sinusitis on three prominent clinical findings , which were also significant factors in diagnosing sinusitis in previous studies . The history of sinusitis might influence patient and physician expectations for the diagnosis The clinical responses of children with upper respiratory infections to 1 of 3 treatment regimens ( tetracycline , penicillin , and placebo ) were evaluated in relation to the bacterial and viral pathogens cultured from nasopharyngeal swabs . The 3 treatment groups were similar in size and in the frequency and type of pathogens recovered . The groups did not differ in their response to the treatment regimens in terms of mean duration of fever , failure to improve , the development of complications , or the persistance of bacterial pathogens in the nasopharynx A minority of patients with upper respiratory tract infections ( URTI ) have a bacterial infection and may benefit from antibiotherapy . In previous investigations we showed that in patients suffering from acute rhinosinusitis associated with the presence of Streptococcus pneumoniae , Haemophilus influenzae or Moraxella catarrhalis in their nasopharygeal secretions , resolution of symptoms was significantly improved by antibiotic treatment . The present analysis was performed to determine whether specific clinical symptoms or signs observed during careful endoscopic examination of the nasal cavities could help the clinician to identify a subset of patients with moderate forms of acute rhinosinusitis infected with pathogenic bacteria . Detailed clinical histories were obtained and medical examinations performed in 265 patients ( 138 females , 127 males ; mean age 35 years ) presenting with a < 4-week history of URTI symptoms but who did not require immediate antibiotic therapy for severe rhinosinusitis . The presence of three pathogenic bacteria ( S. pneumoniae , H. influenzae and M. catarrhalis ) was determined in all patients by culture of nasopharyngeal secretions . Azithromycin ( 500 mg day for 3 days ; n = 133 ) or placebo ( n = 132 ) were r and omly given to all patients in a double-blind manner . Pathogenic bacteria were found in 77 patients ( 29 % ) . The clinical signs and symptoms significantly associated in a multivariate model with the presence of bacteria included colored nasal discharge ( p < 0.003 ) , facial pain ( p < 0.032 ) and radiologically determined maxillary sinusitis ( complete opacity , air-fluid level or mucosal thickening>10 mm ) ( p < 0.001 ) . This best predictive model had a sensitivity of 69 % and a specificity of 64 % and therefore could not be used either as a screening tool or as a diagnostic criterion for bacterial rhinosinusitis . In the group of patients with positive bacterial cultures , resolution of symptoms at Day 7 was observed in 73 % of patients treated with azithromycin and in 47 % of patients in the placebo group ( p < 0.007 ) . We conclude that signs and symptoms of acute rhinosinusitis in patients with mild-to-moder 
    Output:
    
REVIEW ER 'S CONCLUSIONS For children with persistent nasal discharge or older children with radiographically confirmed sinusitis , the available evidence suggests that antibiotics given for 10 days will reduce the probability of persistence in the short to medium-term .
No long term benefits have been documented .