***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: Abstract Objective : To assess three prescribing strategies for sore throat .  Design : R and omised follow up study . Setting : 11 general practice s in the South and West region . Subjects : 716 patients aged 4 years and over with sore throat and an abnormal physical sign in the throat ; 84 % had tonsillitis or pharyngitis . Patients were r and omised to three groups : prescription for antibiotics for 10 days ( group 1 , 246 patients ) ; no prescription ( group 2 , 230 patients ) ; or prescription for antibiotics if symptoms were not starting to settle after three days ( group 3 ; 238 patients ) . Main outcome measures : Duration of symptoms ; satisfaction and compliance with and perceived efficacy of antibiotics ; time off school or work . Outcomes were documented in 582 subjects ( 81 % ) . Results : Median duration of antibiotic use differed significantly in the three groups ( 10 v 0 v 0 days , P<0.001 ) ; 69 % of patients in group 3 did not use their prescription . The proportion of patients better by day 3 did not differ significantly ( 37 % v 35 % v 30 % , P=0.28 ) , nor did the duration of illness ( median 4 v 5 v 5 days , P=0.39 ) , days off work or school ( median 2 v 2 v 1 , P=0.13 ) , or proportion of patients satisfied ( 96 % v 90 % v 93 % , P=0.09 ) , although group 1 had fewer days of fever ( median 1 v 2 v 2 days , P=0.04 ) . More patients in group 1 thought the antibiotics were effective ( 87 % v 55 % v 60 % , P<0.001 ) and intended coming to the doctor in future attacks ( 79 % v 54 % v 57 % , P<0.001 ) . “ Legitimation ” of illness — to explain to work or school ( 60 % ) or family or friends (37%)–was an important reason for consultation . Patients who were more satisfied got better more quickly , and satisfaction related strongly to how well the doctor dealt with patient 's concerns . Conclusion : Prescribing antibiotics for sore throat only marginally affects the resolution of symptoms but enhances belief in antibiotics and intention to consult in future when compared with the acceptable strategies of no prescription or delayed prescription . Psychosocial factors are important in the decision to see a general practitioner and in predicting the duration of illness . Key messages Sore throat is one of the commonest presentations of upper respiratory illness to general practitioners , and attendance is increasing Prescribing antibiotics for sore throat does not reduce the extent and duration of symptoms Prescribing antibiotics enhances belief in antibiotics and intention to consult Legitimation of illness is an important reason for attending the doctor Satisfaction predicts duration of illness and closely relates to how well concerns are dealt with — unless patients are very ill , general practitioners should consider exploring concerns and should avoid or delay prescribing ABSTRACT The purpose of this study was to assess the effectiveness of echinacea for the prevention of  experimental rhinovirus colds . Infection occurred in 44 and 57 % and illness occurred in 36 and 43 % of the  echinacea- and placebo-treated subjects , respectively . This preparation of echinacea had no significant effect on either the occurrence of infection or the severity of illness The incidence of  acute otitis media and its response to treatment only with nose drops and analgesics ( but without antibiotics or myringotomy ) were assessed over three months by 45 doctors in and around Tilburg . In addition , over 17 months 60 general practitioners assessed the effects of this limited treatment in children aged 2 to 12 years and referred all those in whom the condition took an unsatisfactory course ( either a severe course -- illness continuing beyond three to four days with high temperature or pain , or both -- or persistent discharge after 14 days ) to an ear , nose , and throat specialist . Those referred because of appreciable illness continuing beyond three or four days were entered into a further study , comparing the effects of myringotomy alone , antibiotics alone , and myringotomy and antibiotics combined .  Bacteriology was assessed in all children in whom the course of the condition was unsatisfactory . More than 90 % of an estimated 4860 children seen over 17 months ( estimation based on incidence of severe course in the three month study ) recovered within a few days . The course of the condition was severe in only 126 ( 2.7 % ) patients ; haemolytic streptococci group A were identified in 30 of these 126 patients but Haemophilus influenzae in only one . One hundred of these patients with a severe course entered the trial of treatment , which showed antimicrobial treatment  either alone or in combination to be more effective than myringotomy alone . Whether combined treatment was more effective than antibiotics alone remained unconfirmed .  Acute otitis media in children can be treated with nose drops and analgesics alone for the first three to four days . Patients in whom this regimen is not accompanied by satisfactory recovery can be recognised within a short time and treated by the general practitioner Moraxella catarrhalis and Hemophilus influenzae are isolated from the nasopharynx in 50 % to 55 % and 8 % to 15 % , respectively , of cases of acute laryngitis in adults . This finding indicates that these organisms , M catarrhalis in particular , are in some way involved in the pathogenesis of the disorder . In the present double-blind , placebo-controlled trial , the effect of erythromycin ethylsuccinate ( 0.5 g twice a day for 5 days ) on the elimination of nasopharyngeal pathogens and reduction of clinical signs of upper respiratory tract infection , as well as on subjective complaints , was evaluated in 106 adults with acute laryngitis . The bacterial isolation rates at presentation were M catarrhalis 50 % , H influenzae 18 % , and Streptococcus pneumoniae 4 % . In the 99 patients who completed the study , the elimination of M catarrhalis after 1 week was better in the erythromycin group ( 25 of 30 cases ) than in the placebo group ( 6 of 19 cases ; p ≤ .00038 ) . The elimination of H influenzae was unaffected by erythromycin . Otolaryngologic examination did not reveal any significant group differences regarding laryngitis , pharyngitis , or rhinitis . Voice quality was improved after 1 week , irrespective of treatment . However , as compared to the placebo group , the erythromycin group reported fewer voice complaints after 1 week and fewer coughing complaints after 2 weeks . As acute laryngitis in adults is self-limiting , and subjective symptoms are spontaneously reduced after 1 week in most cases , antibiotic treatment does not seem warranted as a general policy . However , erythromycin may be justified in patients who are professionally dependent on voice function BACKGROUND Acute sinusitis-like complaints are very common and are usually treated with antibiotics in spite of the lack of evidence for the effectiveness of antibiotic therapy and the increasing number of resistant strains . AIM To assess the effectiveness of doxycycline in adults with acute sinusitis-like complaints in general practice . METHOD The effects of doxycycline in a placebo-controlled , double-blind , r and omized trial were assessed in adults consulting their general practitioner ( GP ) with complaints after a common cold or influenza , pain in the head when bending forward , purulent nasal discharge , predominantly unilateral maxillary pain , toothache , or pain when chewing . Primary outcome events were the resolution of facial pain and the resumption of daily activities . Treatment differences were assessed by means of Kaplan-Meier curves and hazard ratios . The follow-up period was 42 days . RESULTS No significant difference was found in time to recover between the doxycycline-treated group and the placebo-treated group . However , the adjusted hazard ratio for the group receiving doxycycline was 1.17 ( 95 % CI = 0.87 - 1.57 ) for the resolution of pain and 1.31 ( 95 % CI = 0.96 - 1.78 ) for the resumption of daily activities . After 10 days , 85 % of all patients reported improvement and 60 % were completely cured . Side effects were reported by 17 % of the doxycycline-treated group , with two patients withdrawing because of side effects . CONCLUSIONS Data from this study indicate that doxycycline does not add to the effectiveness of decongestive nose drops and steam inhalation in treating acute sinusitis-like complaints in general practice adults Two recent review s question ed the routine use of antibiotics in the initial management of  acute otitis media .  1 2 My practice partners and I responded to the review s by changing our policy , with the aim of reducing such prescribing in children . We measured the change one year after adopting the new policy . From July 1997 my practice partners and I changed our policy on routine prescription of antibiotics in the initial management of  acute otitis media in children . In children who were not particularly ill we gave the parents a h and out that summarised the limited benefit of antibiotics on the basis of the data presented in the Cochrane review .1 We advised parents to give regular paracetamol suspension ; we also offered an antibiotic prescription but asked the parents to keep it for a day or two . They could redeem it at a pharmacy if the child did not got better over this period . A local practice acted as a concurrent control . Both practice s use To determine the epidemiology of otitis media ( OM ) during the first three years of life , physicians participating in the Greater Boston Collaborative Otitis Media Program followed prospect ively from birth 2,565 children . At every visit we recorded results of pneumatic otoscopy and epidemiology data . By three years of age 71 % of the children had had one or more episodes of acute otitis media including 33 % who had three or more episodes . Features associated significantly with first episode of OM were : sibling with recurrent OM , race ( white > black ) , and sex ( male > female ) . Having a sibling with allergy disposed propositi to first episode . Features associated significantly with recurrent OM ( ≥ three episodes ) were those noted above . A parent with recurrent OM disposed propositi to recurrent OM . Middle ear effusion ( MEE ) persisted for prolonged periods after OM ; after the first episode of OM , 70 % of children still had MEE at two weeks , 40 % had fluid at one month , 20 % had fluid at two months , and 10 % had fluid at three months . The sole feature associated significantly with persistent effusion in the middle ear after the first episode of OM was the practice of giving a child a bottle in bed STUDY OBJECTIVE --The relation between a history of disorders suggestive of acute otitis media , symptoms , and findings of an examination of the tympanic membrane and doctors ' certainty of diagnosis . Also , to examine differences in prescribing habits for acute otitis media among doctors from different countries . DESIGN -- Question naires were completed by participating doctors for a maximum of 15 consecutive patients presenting with presumed acute otitis media . SETTING --General practice s in Australia , Belgium , Great Britain , Israel , The Netherl and s , New Zeal and , Canada , Switzerl and , and the United States . PATIENTS --3660 Children divided into the three age groups 0 - 12 months , 13 - 30 months , and greater than or equal to 31 months . MAIN OUTCOME MEASURES --General practitioners ' responses to questions on their diagnostic certainty and resolution of patients ' symptoms after two months . RESULTS --The diagnostic certainty in patients aged 0 - 12 months was 58.0 % . This increased to 66.0 % in those aged 13 - 30 months and 73.3 % in those aged greater than or equal to 31 months . In all age groups diagnostic certainty was positively associated with the finding of a tympanic membrane that was discharging pus or bulging . Redness of the membrane and pain were also associated with certainty in patients aged 13 - 30 months , and a history of decreased hearing or recent upper respiratory infection was positively associated in patients aged greater than or equal to 31 months . The proportion of patients prescribed antibiotics  varied greatly among the countries , from 31.2 % in The Netherl and s to 98.2 % in both Australia and New Zeal and , as did the duration of treatment . Patients who did not take antibiotics had a higher rate of recovery than those who did ; the rate of recovery did not differ between different types of antibiotic . CONCLUSIONS --Doctors ' certainty of diagnosis of acute otitis media was linked to patient 's age . Improved criteria or techniques for diagnosing acute otitis media , especially in very young children , need to be developed . Antibiotic treatment did not improve the rate of recovery of patients in this study Patients with acute laryngitis following an upper respiratory tract infection are often treated with antibiotics for their voice complaints , although , to our knowledge , the effect of such therapy has not been examined . In the present study , comprising 100 adults with laryngitis , the rate of resolution of vocal symptoms , as estimated from voice recordings or subjectively by the patients , was the same in patients who received penicillin V ( pcV ) as in those who received placebo . Similarly , the degree of rhinorrhea/nasal congestion and cough was not significantly influenced by pcV treatment . At the acute visit , nasopharyngeal cultures revealed Branhamella catarrhalis in 50 % , Hemophilus influenzae in 1 
    Output:
    
A scoring system can help to increase the likelihood of distinguishing a streptococcal as opposed to viral infection , or alternatively patients should be given antibacterials only if certain conditions are fulfilled .
In  otitis media with effusion  , on the other h and , there is no primary role for antibacterials , as the condition resolves naturally in almost all patients aged > 3 months .