***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: CONTEXT Evidence to support antibiotic treatment for acute rhinosinusitis is limited , yet antibiotics are commonly used . OBJECTIVE To determine the incremental effect of amoxicillin treatment over symptomatic treatments for adults with clinical ly diagnosed acute rhinosinusitis . DESIGN , SETTING , AND PARTICIPANTS A r and omized , placebo-controlled trial of adults with uncomplicated , acute rhinosinusitis were recruited from 10 community practice s in Missouri between November 1 , 2006 , and May 1 , 2009 . INTERVENTIONS Ten-day course of either amoxicillin ( 1500 mg/d ) or placebo administered in 3 doses per day . All patients received a 5- to 7-day supply of symptomatic treatments for pain , fever , cough , and nasal congestion to use as needed . MAIN OUTCOME MEASURES The primary outcome was improvement in disease-specific quality of life after 3 to 4 days of treatment assessed with the Sinonasal Outcome Test-16 ( minimally important difference of 0.5 units on a 0 - 3 scale ) . Secondary outcomes included the patient 's retrospective assessment of change in sinus symptoms and functional status , recurrence or relapse , and satisfaction with and adverse effects of treatment . Outcomes were assessed by telephone interview at days 3 , 7 , 10 , and 28 . RESULTS A total of 166 adults ( 36 % male ; 78 % with white race ) were r and omized to amoxicillin ( n = 85 ) or placebo ( n = 81 ) ; 92 % concurrently used 1 or more symptomatic treatments ( 94 % for amoxicillin group vs 90 % for control group ; P = .34 ) . The mean change in Sinonasal Outcome Test-16 scores was not significantly different between groups on day 3 ( decrease of 0.59 in the amoxicillin group and 0.54 in the control group ; mean difference between groups of 0.03 [ 95 % CI , -0.12 to 0.19 ] ) and on day 10 ( mean difference between groups of 0.01 [ 95 % CI , -0.13 to 0.15 ] ) , but differed at day 7 favoring amoxicillin ( mean difference between groups of 0.19 [ 95 % CI , 0.024 to 0.35 ] ) . There was no statistically significant difference in reported symptom improvement at day 3 ( 37 % for amoxicillin group vs 34 % for control group ; P = .67 ) or at day 10 ( 78 % vs 80 % , respectively ; P = .71 ) , whereas at day 7 more participants treated with amoxicillin reported symptom improvement ( 74 % vs 56 % , respectively ; P = .02 ) . No between-group differences were found for any other secondary outcomes . No serious adverse events occurred . CONCLUSION Among patients with acute rhinosinusitis , a 10-day course of amoxicillin compared with placebo did not reduce symptoms at day 3 of treatment . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00377403 In this double-blind , parallel-group , multicenter study , 169 patients with symptoms of maxillary sinusitis but without radiographically confirmed empyema ( pus ) were r and omly assigned to receive either 500 mg azithromycin once daily for 3 days ( 87 patients ) or placebo daily for 3 days ( 82 patients ) . Nasal secretion , maxillary tenderness and pain , nasal obstruction , general malaise , and hyposmia were assessed at the start of the study and on days 4 , 11 , and 25 of treatment . After 11 days 58 % of the patients in the azithromycin group were cured versus 31 % in the placebo group ; after 25 days the cure rate was 79 % versus 67 % , respectively . When both cure and improvement were considered , the corresponding figures after day 25 were 90 % and 88 % , respectively . Adverse events , predominantly gastrointestinal , occurred in 24 ( 27 % ) of the azithromycin-treated patients and in 15 ( 18 % ) of those treated with placebo , but the difference was not statistically significant . There was a difference in efficacy in favor of azithromycin in the treatment of rhinitis with symptoms of maxillary sinusitis but without radiological signs of empyema ( pus ) . Antibiotics should only be used to alleviate symptoms in patients with moderate to severe symptoms , as the results after 25 days for both improvement and cure are equal . In the treatment of acute rhinitis with symptoms and signs of maxillary sinusitis but without empyema , treatment with azithromycin seems to result in a better cure rate after 10–12 days when compared with placebo OBJECTIVE To compare the efficacy of amoxicillin vs placebo in patients with an acute upper respiratory tract infection and purulent rhinorrhea . STUDY DESIGN Double-blind r and omized placebo-controlled trial . POPULATION The 416 patients included from 69 family practice s were 12 years or older , presenting with acute upper respiratory complaints , and having a history of purulent rhinorrhea and no signs of complications of sinusitis . OUTCOMES MEASURED Therapy success ( disappearance of symptoms that most greatly affected the patient 's health ) at day 10 and duration of general illness , pain , and purulent rhinorrhea . RESULTS Therapy was successful in 35 % of patients with amoxicillin and in 29 % of patients with placebo ( relative risk [ RR ] 1.14 , 95 % confidence interval [ CI ] , 0.92 - 1.42 ) . There was no effect on duration of general illness or pain . Duration of purulent rhinorrhea was shortened by amoxicillin ( 9 days vs 14 for clearing of purulent rhinorrhea in 75 % of patients ; P = .007 ) . Diarrhea was more frequent with amoxicillin ( 29 % vs 19 % , RR 1.28 , 95 % CI , 1.05 - 1.57 ) . No complications were reported . One patient ( 0.5 % ) receiving amoxicillin and 7 ( 3.4 % ) receiving placebo discontinued trial therapy because of exacerbation of symptoms ( RR 0.25 , 95 % CI 0.04 - 1.56 , P = .07 ) . All 8 patients recovered with antibiotic therapy . CONCLUSIONS Amoxicillin has a beneficial effect on purulent rhinorrhea caused by an acute infection of the nose or sinuses but not on general recovery . The practical implication is that all such patients , whatever the suspected diagnosis , can be safely treated with symptomatic therapy and instructed to return if symptoms worsen PURPOSE To reduce inappropriate antibiotic prescribing , we sought to develop a clinical decision rule for the diagnosis of acute rhinosinusitis and acute bacterial rhinosinusitis . METHODS Multivariate analysis and classification and regression tree ( CART ) analysis were used to develop clinical decision rules for the diagnosis of acute rhinosinusitis , defined using 3 different reference st and ards ( purulent antral puncture fluid or abnormal finding on a computed tomographic ( CT ) scan ; for acute bacterial rhinosinusitis , we used a positive bacterial culture of antral fluid ) . Signs , symptoms , C-reactive protein ( CRP ) , and reference st and ard tests were prospect ively recorded in 175 Danish patients aged 18 to 65 years seeking care for suspected acute rhinosinusitis . For each reference st and ard , we developed 2 clinical decision rules : a point score based on a logistic regression model and an algorithm based on a CART model . We identified low- , moderate- , and high-risk groups for acute rhinosinusitis or acute bacterial rhinosinusitis for each clinical decision rule . RESULTS The point scores each had between 5 and 6 predictors , and an area under the receiver operating characteristic curve ( AUROCC ) between 0.721 and 0.767 . For positive bacterial culture as the reference st and ard , low- , moderate- , and high-risk groups had a 16 % , 49 % , and 73 % likelihood of acute bacterial rhinosinusitis , respectively . CART models had an AUROCC ranging from 0.783 to 0.827 . For positive bacterial culture as the reference st and ard , low- , moderate- , and high-risk groups had a likelihood of acute bacterial rhinosinusitis of 6 % , 31 % , and 59 % respectively . CONCLUSIONS We have developed a series of clinical decision rules integrating signs , symptoms , and CRP to diagnose acute rhinosinusitis and acute bacterial rhinosinusitis with good accuracy . They now require prospect i ve validation and an assessment of their effect on clinical and process outcomes CONTEXT Acute sinusitis is a common clinical problem that usually results in a prescription for antibiotics but the role of antibiotics is debated . Anti-inflammatory drugs such as topical steroids may be beneficial but are under research ed . OBJECTIVE To determine the effectiveness of amoxicillin and topical budesonide in acute maxillary sinusitis .  DESIGN , SETTING , AND PATIENTS A double-blind , r and omized , placebo-controlled factorial trial of 240 adults ( aged > or = 16 years ) with acute nonrecurrent sinusitis ( had > or = 2 diagnostic criteria : purulent rhinorrhea with unilateral predominance , local pain with unilateral predominance , purulent rhinorrhea bilateral , presence of pus in the nasal cavity ) at 58 family practice s ( 74 family physicians ) between November 2001 and November 2005 . Patients were r and omized to 1 of 4 treatment groups : antibiotic and nasal steroid ; placebo antibiotic and nasal steroid ; antibiotic and placebo nasal steroid ; placebo antibiotic and placebo nasal steroid . INTERVENTION A dose of 500 mg of amoxicillin 3 times per day for 7 days and 200 mug of budesonide in each nostril once per day for 10 days . MAIN OUTCOME MEASURES Proportion clinical ly cured at day 10 using patient symptom diaries and the duration and severity of symptoms . RESULTS The proportions of patients with symptoms lasting 10 or more days were 29 of 100 ( 29 % ) for amoxicillin vs 36 of 107 ( 33.6 % ) for no amoxicillin ( adjusted odds ratio , 0.99 ; 95 % confidence interval , 0.57 - 1.73 ) . The proportions of patients with symptoms lasting 10 or more days were 32 of 102 ( 31.4 % ) for topical budesonide vs 33 of 105 ( 31.4 % ) for no budesonide ( adjusted odds ratio , 0.93 ; 95 % confidence interval , 0.54 - 1.62 ) . Secondary analysis suggested that nasal steroids were significantly more effective in patients with less severe symptoms at baseline . CONCLUSION Neither an antibiotic nor a topical steroid alone or in combination was effective as a treatment for acute sinusitis in the primary care setting . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N60825437 BACKGROUND Sinusitis is the fifth most common reason for patients to visit primary care physicians , yet clinical outcomes relevant to patients are seldom studied . OBJECTIVE To determine whether patients with purulent rhinitis , " sinusitis-type symptoms , " improved with antibiotics . Second , to examine a clinical prediction rule to provide preliminary validation data . METHODS Prospect i ve clinical trial , with double-blinded placebo controlled r and omization . The setting was a suburb of Washington , DC , from Oct 1 , 2001 , to March 31 , 2003 . All participants were 18 years or older , presenting to a family practice clinic with a complaint of sinusitis and with pus in the nasal cavity , facial pressure , or nasal discharge lasting longer than 7 days . The main outcome measures were resolution of symptoms within a 14-day follow-up period and the time to improvement ( days ) . RESULTS After exclusion criteria , 135 patients were r and omized to either placebo ( n=68 ) or amoxicillin ( n=67 ) for 10 days . Intention-to-treat analyses showed that 32 ( 48 % ) of the amoxicillin group vs 25 ( 37 % ) of the placebo group ( P=.26 ) showed complete improvement by the end of the 2-week follow-up period ( relative risk=1.3 ; 95 % confidence interval [ CI ] , 0.87 - 1.94 ] ) . Although the rates of improvement were not statistically significantly different at the end of 2 weeks , the amoxicillin group improved significantly earlier , in the course of treatment , a median of 8 vs 12 days , than did the placebo group ( P=.039 ) . CONCLUSION For most patients with sinusitis-type complaints , no improvement was seen with anti-biotics over placebo . For those who did improve , data suggested there is a subgroup 
    Output:
    
Considering antibiotic resistance , and the very low incidence of serious complications , we conclude there is no place for antibiotics for people with uncomplicated acute rhinosinusitis .