***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: Respiratory syncytial virus ( RSV ) bronchiolitis is the most common lower respiratory tract infection in infancy . To date , there is no effective therapy for RSV bronchiolitis . In order to investigate the efficacy of clarithromycin in the treatment of RSV bronchiolitis , the present authors conducted a r and omised , double-blind , placebo-controlled trial comparing clarithromycin with placebo in 21 infants with a diagnosis of RSV bronchiolitis . The infants were r and omised to receive clarithromycin or placebo daily for 3 weeks . Levels of interleukin (IL)-4 , IL-8 , eotaxin , and interferon-γ were determined in plasma , before and after treatment , using ELISA . Six months after treatment , parents were surveyed as to whether their child had experienced wheezing within the previous 6 months . Treatment with clarithromycin was associated with a statistically significant reduction in the length of hospital stay , the duration of need for supplemental oxygen and the need for β2-agonist treatment . There were significant decreases in plasma IL-4 , IL-8 and eotaxin levels after 3 weeks of treatment with clarithromycin  . Readmission to the hospital within 6 months after discharge was significantly lower in the clarithromycin group . In conclusion , clarithromycin has statistically significant effects on the clinical and laboratory findings in respiratory syncytial virus bronchiolitis . Therefore , clarithromycin treatment may be helpful in reducing the short-term effects of respiratory syncytial virus bronchiolitis Background : Respiratory syncytial virus ( RSV ) is the most common cause of viral lower respiratory tract infections ( LRTI ) . Viral LRTI is a risk factor for bacterial superinfection , having an escalating incidence with increasing severity of respiratory illness . A study was undertaken to determine the incidence of pulmonary bacterial co-infection in infants and children with severe RSV bronchiolitis , using paediatric intensive care unit ( PICU ) admission as a surrogate marker of severity , and to study the impact of the co-infection on morbidity and mortality . Methods : A prospect i ve microbiological analysis was made of lower airways secretions on all RSV positive bronchiolitis patients on admission to the PICU during three consecutive RSV seasons . Results : One hundred and sixty five children ( median age 1.6 months , IQR 0.5–4.6 ) admitted to the PICU with RSV bronchiolitis were enrolled in the study . Seventy ( 42.4 % ) had lower airway secretions positive for bacteria : 36 ( 21.8 % ) were co-infected and 34 ( 20.6 % ) had low bacterial growth/possible co-infection . All were mechanically ventilated ( median 5.0 days , IQR 3.0–7.3 ) . Those with bacterial co-infection required ventilatory support for longer than those with only RSV ( p<0.01 ) . White cell count , neutrophil count , and C-reactive protein did not differentiate between the groups . Seventy four children ( 45 % ) received antibiotics prior to intubation . Sex , co-morbidity , origin , prior antibiotics , time on preceding antibiotics , admission oxygen , and ventilation index were not predictive of positive bacterial cultures . There were 12 deaths ( 6.6 % ) , five of which were related to RSV . Conclusions : Up to 40 % of children with severe RSV bronchiolitis requiring admission to the PICU were infected with bacteria in their lower airways and were at increased risk for bacterial pneumonia Objective Bronchiolitis , one of the most common reasons for hospitalisation in young children , is particularly problematic in Indigenous children . Macrolides may be beneficial in setting s where children have high rates of nasopharyngeal bacterial carriage and frequent prolonged illness . The aim of our double-blind placebo-controlled r and omised trial was to determine if a large single dose of azithromycin ( compared to placebo )  reduced length of stay ( LOS ) , duration of oxygen ( O2 ) and respiratory readmissions within 6 months of children hospitalised with bronchiolitis . We also determined the effect of azithromycin on nasopharyngeal microbiology . Methods Children aged ≤18 months were r and omised to receive a single large dose ( 30 mg/kg ) of either azithromycin or placebo within 24 hrs of hospitalisation . Nasopharyngeal swabs were collected at baseline and 48hrs later . Primary endpoints ( LOS , O2 ) were monitored every 12 hrs . Hospitalised respiratory readmissions 6-months post discharge was collected . Results 97 children were r and omised ( n = 50 azithromycin , n = 47 placebo ) . Median LOS was similar in both groups ; azithromycin = 54 hours , placebo = 58 hours ( difference between groups of 4 hours 95%CI -8 , 13 , p = 0.6 ) . O2 requirement was not significantly different between groups ; Azithromycin = 35 hrs ; placebo = 42 hrs ( difference 7 hours , 95%CI -9 , 13 , p = 0.7 ) . Number of children re-hospitalised was similar 10 per group ( OR = 0.9 , 95%CI 0.3 , 2 , p = 0.8 ) . At least one virus was detected in 74 % of children . The azithromycin group had reduced nasopharyngeal bacterial carriage ( p = 0.01 ) but no difference in viral detection at 48 hours . Conclusion Although a single dose of azithromycin reduces carriage of bacteria , it is unlikely to be beneficial in reducing LOS , duration of O2 requirement or readmissions in children hospitalised with bronchiolitis . It remains uncertain if an earlier and /or longer duration of azithromycin  improves clinical and microbiological outcomes for children . The trial was registered with the Australian and New Zeal and Clinical Trials Register . Clinical trials number : ACTRN12608000150347 . http://www.anzctr.org.au/Trial Search .aspx OBJECTIVE To test the hypothesis that azithromycin reduces the length of hospitalization and oxygen requirement in infants with acute viral bronchiolitis ( AB ) . STUDY DESIGN We performed a r and omized , double-blinded , placebo-controlled trial in southern Brazil , from 2009 to 2011 . Infants ( < 12 months of age ) hospitalized with AB were recruited in 2 hospitals . Patients were r and omized to receive either azithromycin or placebo , administered orally , for 7 days . At enrollment , clinical data were recorded and nasopharyngeal sample s were collected for viral identification through immunofluorescence . Main outcomes were duration of oxygen requirement and length of hospitalization . RESULTS One hundred eighty-four patients were included in the study  ( azithromycin 88 subjects , placebo 96 subjects ) . Baseline clinical characteristics and viral identification were not different between the groups studied . A virus was detected in 112 ( 63 % ) patients , and of those , 92 % were positive for respiratory syncytial virus . The use of azithromycin did not reduce the median number of days of either hospitalization ( P = .28 ) or oxygen requirement ( P = .47 ) . CONCLUSIONS Azithromycin did not improve major clinical outcomes in a large sample of hospitalized infants with AB , even when restricting the findings to those with positive respiratory syncytial virus sample s. Azithromycin therapy should not be given for AB because it provides no benefit and overuse increases overall antibiotic resistance Routine administration of antibiotics in the treatment of pneumonia and bronchiolitis in infants and small children was evaluated in an open r and omised prospect i ve trial . From 1979 - 82 136 children between the age of 1 month and 6 years were allocated to one of two treatment groups shortly after their admission to a paediatric ward . Group A patients were to be given antibiotics but those in group B were not . None of the children had received antibiotics before hospital admission . A viral infection was diagnosed in 38 of the 72 patients from group A and in 34 of the 64 patients from group B. Respiratory syncytial virus was detected in 84 % of these patients . Sample s of tracheal secretions showed no differences between the groups in respect of cytology and bacterial flora . Nor were there any significant differences in the course of acute disease , the frequency of fever relapse and pulmonary complications . Fifteen patients from group B were subsequently treated with antibiotics : two of these developed secondary purulent infections of the middle ear and one showed a slight pleural effusion . These results do not support the routine use of antibiotics in infants and small children admitted to hospital with pneumonia and bronchiolitis Common variable immunodeficiency ( CVID ) is characterized by defective B cell function , impaired antibody production , and increased susceptibility to bacterial infections . Here , we addressed the hypothesis that poor antibody-mediated immune control of infections may result in substantial perturbations in the T cell compartment . Newly diagnosed CVID patients were sample d before , and 6–12 months after , initiation of intravenous immunoglobulin ( IVIg ) therapy . Treatment-naïve CVID patients displayed suppressed CD4 T cell counts and myeloid dendritic cell ( mDC ) levels , as well as high levels of immune activation in CD8 T cells , CD4 T cells , and invariant natural killer T ( iNKT ) cells . Expression of co-stimulatory receptors CD80 and CD83 was elevated in mDCs and correlated with T cell activation . Levels of both FoxP3 + T regulatory ( Treg ) cells and iNKT cells were low , whereas soluble CD14 ( sCD14 ) , indicative of monocyte activation , was elevated . Importantly , immune reconstitution treatment with IVIg partially restored the CD4 T cell and mDC compartments . Treatment furthermore reduced the levels of CD8 T cell activation and mDC activation , whereas levels of Treg cells and iNKT cells remained low . Thus , primary deficiency in humoral immunity with impaired control of microbial infections is associated with significant pathological changes in cell-mediated immunity . Furthermore , therapeutic enhancement of humoral immunity with IVIg infusions alleviates several of these defects , indicating a relationship between poor antibody-mediated immune control of infections and the occurrence of abnormalities in the T cell and mDC compartments . These findings help our underst and ing of the immunopathogenesis of primary immunodeficiency , as well as acquired immunodeficiency caused by HIV-1 infection OBJECTIVES . The goals were to describe the ( 1 ) frequency of sepsis evaluation and empiric antibiotic treatment  , ( 2 ) clinical predictors of management , and ( 3 ) serious bacterial illness frequency for febrile infants with clinical ly diagnosed bronchiolitis seen in office setting s. METHODS . The Pediatric Research in Office Setting s network conducted a prospect i ve cohort study of 3066 febrile infants ( <3 months of age with temperatures ≥38 ° C ) in 219 practice s in 44 states . We compared the frequency of  sepsis evaluation , parenteral antibiotic treatment , and serious bacterial illness  in infants with and without clinical ly diagnosed bronchiolitis . We identified predictors of  sepsis evaluation and parenteral antibiotic treatment in infants with bronchiolitis by using logistic regression models . RESULTS . Practitioners were less likely to perform a complete sepsis evaluation , urine testing , and cerebrospinal fluid culture and to administer parenteral antibiotic treatment for infants with bronchiolitis , compared with those without bronchiolitis . Significant predictors of sepsis evaluation in infants with bronchiolitis included younger age , higher maximal temperature , and respiratory syncytial virus testing . Predictors of parenteral antibiotic use included initial ill appearance , age of < 30 days , higher maximal temperature , and general signs of infant distress . Among infants with bronchiolitis ( N = 218 ) , none had serious bacterial illness and those with respiratory distress signs were less likely to receive parenteral antibiotic treatment . Diagnoses among 2848 febrile infants without bronchiolitis  included bacterial meningitis ( n = 14 ) , bacteremia ( n = 49 ) , and urinary tract infection ( n = 167 ) . CONCLUSIONS . In office setting s , serious bacterial illness in young febrile infants with clinical ly diagnosed bronchiolitis is uncommon . Limited testing for bacterial infections seems to be an appropriate management strategy BACKGROUND Nearly half of all hospitalized infants with respiratory syncytial virus ( RSV ) lower respiratory tract disease ( LRTD ) are treated with ( parenteral ) antibiotics . The present study was design ed to test our hypothesis that the use of antibiotics would not lead to a reduced duration of hospitalization in mild to moderate RSV LRTD . METHODS Seventy-one patients < or = 24 months of age with a virologically confirmed clinical diagnosis of RSV LRTD were r and omized to azithromycin 10 mg/kg/day ( n = 32 ) or placebo ( n = 39 ) in a multicenter , r and omized , double-blind , placebo-controlled equivalence trial during three RSV seasons ( 2002 - 2004 through 2005 - 2006 ) . Primary endpoint was duration of hospitalization , secondary endpoints included duration of oxygen supplementation and nasogastric t 
    Output:
    
This review did not find sufficient evidence to support the use of antibiotics for bronchiolitis , although research may be justified to identify a subgroup of patients who may benefit from antibiotics .