***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: Objectives : To evaluate the efficacy and safety of a therapeutic bacteriophage preparation ( Biophage‐PA ) targeting antibiotic‐resistant Pseudomonas aeruginosa in chronic otitis Objectives . Antimicrobial treatment may disturb the colonization resistance of gastrointestinal microflora , which may induce clinical symptoms , most commonly diarrhea . The severity of antibiotic-associated diarrhea may range from a brief , self-limiting disease to devastating diarrhea with electrolyte disturbances , dehydration , crampy abdominal pain , pseudomembranous colitis , toxic megacolon , or even death . The incidence of diarrhea in children receiving a single antimicrobial treatment is unclear . In addition to more critical use of antimicrobials , adjunctive preventive measures to antibiotic-associated diarrhea are needed . The objective of this study was to evaluate the incidence of diarrhea after antimicrobial treatment in children with no history of antimicrobial use during the previous 3 months . Another aim of this study was to assess the preventive potential of Lactobacillus rhamnosus GG ( Lactobacillus GG ; American Type Culture Collection 53103 ) , a probiotic strain with a documented safety record and a therapeutic effect in viral gastroenteritis on antibiotic-associated diarrhea . Methods . Oral antimicrobial agents were prescribed for the treatment of acute respiratory infections at the clinics of the Health Care Center of the City of Tampere or Tampere University Hospital , Finl and , to 167 patients who were invited to participate in the study . Of the patients , 48 were lost to follow-up ; therefore , the final study population consisted of 119 children from 2 weeks to 12.8 years of age ( mean : 4.5 years ) . All study subjects met the inclusion criteria : they had not received any antimicrobial medication during the previous 3 months , they did not suffer from gastrointestinal disorders , and they did not need intravenous antimicrobial treatment . The patients were r and omized to receive placebo or 2 × 1010 colony-forming units of Lactobacillus GG in capsules given twice daily during the antimicrobial treatment . Lactobacillus GG and placebo capsules were indistinguishable in appearance and taste . The parents kept a daily symptom diary and recorded stool frequency and consistency at home for 3 months . Diarrhea was defined as at least three watery or loose stools per day for a minimum of 2 consecutive days . In the case of diarrhea , viral ( adenovirus , rotavirus , calicivirus and astrovirus ) and bacterial ( Salmonella , Shigella , Yersinia , Campylobacter , Clostridium difficile , Staphylococcus aureus , and yeasts ) analyses were studied in fecal sample s. The metabolic activity of the gut microflora was assessed by analysis of fecal urease , β-glucosidase , and β-glucuronidase activities . The primary outcome measure was diarrhea during the first 2 weeks after the beginning of the antimicrobial treatment , because this period most likely reflects the effects of antimicrobial use . Secondary outcome measures were the activities of fecal urease , β-glucuronidase , and β-glucosidase . Results . On the entire follow-up , 80 % of any gastrointestinal symptoms were reported during the first 2 weeks after the beginning of the antimicrobial treatment . The incidence of diarrhea was 5 % in the  Lactobacillus GG group and 16 % in the placebo group within 2 weeks of antimicrobial therapy ( χ2 = 3.82 ) . The treatment effect ( 95 % confidence interval ) of Lactobacillus GG was −11 % ( −21%–0 % ) . In diarrheal episodes , the viral and bacterial analyses were positive for Clostridium difficile in 2 cases and for Norwalk-like calicivirus in 3 cases . The age of the patients with diarrhea was between 3 months and 5 years in 75 % of cases in both groups .  The severity of diarrhea was comparable in the study groups , as evidence d by similar stool frequency ( mean : 5 per day ; range : 3–6 ) and the duration of diarrhea ( mean : 4 days ; range : 2–8 ) . The activities of fecal urease and β-glucuronidase , but not β-glucosidase , changed significantly after the beginning of the antimicrobial treatment in the Lactobacillus GG group and in the placebo group alike . The decrease in urease and β-glucuronidase activities was reversible in patients with no diarrhea , but in patients with diarrhea , the modifications in gut microflora were more profound and prolonged . The activities of the three enzymes were normalized within 3 weeks , evidence d by stable enzyme activities in sample s collected 3 weeks , 1 month , and 3 months after the beginning of the antimicrobial treatment , compared with those obtained before treatment . Discussion . In the present study , after a single antimicrobial treatment , the incidence of diarrhea was 16 % . The higher incidence of antibiotic-associated diarrhea in previous reports may be attributable to a recent antimicrobial therapy that disturbs intestinal flora and exposes to complications . Also , in the present study , changes in the metabolic activity of the intestinal flora were observed , evidence d by a transient decline in fecal enzyme activities . Different probiotic preparations , including lactobacilli , are recommended frequently to prevent antibiotic-associated diarrhea . Although probiotics have been shown to be efficient in the prevention and the treatment of viral gastroenteritis , their usefulness during antimicrobial therapy in children has not been eluci date d before . We observed that the administration of Lactobacillus GG to children receiving antimicrobial therapy for respiratory infection reduced the incidence of antibiotic-associated diarrhea to one third . The beneficial effect may be mediated by a number of functions of probiotics , ie , production of antimicrobial substances , local competition of adhesion receptors and nutrients , and stimulation of intestinal antigen specific and nonspecific immune responses . Conclusion . A probiotic strain , Lactobacillus GG , is effective in the prevention of diarrhea in children receiving antimicrobial treatment to respiratory infections The addition of probiotics to infant formula has been shown to be an efficient way to increase the number of beneficial bacteria in the intestine in order to promote a gut flora resembling that of breast-fed infants . The objective of the present study was to evaluate the safety and tolerance of a combination of two probiotic strains in early infancy . A group of 126 newborns were r and omised to receive a prebiotic-containing starter formula supplemented with Lactobacillus paracasei ssp . paracasei and Bifidobacterium animalis ssp . lactis or the same formula without probiotics for the first 3 months of life . A total of eighty infants continued the study until they were aged 6 months .  Growth measurements were taken monthly at healthy baby clinics . Diaries were used to monitor behaviour , infections , use of antibiotics , as well as stool characteristics . Normal growth occurred in all infants and no statistically significant differences were detected between the probiotics group and the control group for gain in weight , length and head circumference . Infants in the probiotics group produced softer and more frequent stools during the first 3 months of life . No differences were found in crying and sleeping hours , number of parent-diagnosed infections , antibiotic use , visits to the general practitioner and number of adverse events . The use of a prebiotic-containing starter formula supplemented with L. paracasei ssp . paracasei and B. animalis ssp . lactis in early infancy is safe , well tolerated and has no adverse effects on growth and infant behaviour Background : To evaluate whether a fermented dairy drink containing the probiotic strain Lactobacillus casei DN-114 001 could reduce the incidence of common infectious diseases ( CIDs ) and the change of behavior because of illness in children . Subjects/ Methods : We conducted a double-blinded , r and omized , placebo-controlled allocation concealment clinical trial in the Washington , DC metropolitan area . Participants were 638 children 3–6 years old in daycare/schools . The intervention was a fermented dairy drink containing a specific probiotic strain or matching placebo with no live cultures for 90 consecutive days . Two primary outcomes were assessed : incidence of CIDs and change of behavior because of illness ( both assessed by parental report ) . Results : The rate of change of behavior because of illness was similar among active and control groups . However , the incidence rate for CIDs in the active group ( 0.0782 ) is 19 % lower than that of the control group ( 0.0986 ) ( incidence rate ratio=0.81 , 95 % CI : 0.65 , 099 ) P=0.046 . Conclusions : Daily intake of a fermented dairy drink containing the probiotic strain L. casei DN-114 001 showed some promise in reducing overall incidence of illness , but was primarily driven by gastrointestinal infections and there were no differences in change of behavior Background : This pilot study investigates the efficacy of a probiotic consortium ( Lab4 ) in combination with vitamin C on the prevention of respiratory tract infections in children attending preschool facilities . Subjects/ methods : In a double-blind , r and omised , placebo-controlled pilot study with children aged 3–6 years , 57 received 1.25 × 1010 colony-forming units of Lactobacillus acidophilus CUL21 ( NCIMB 30156 ) , Lactobacillus acidophilus CUL60 ( NCIMB 30157 ) , Bifidobacterium bifidum CUL20 ( NCIMB 30153 ) and Bifidobacterium animalis subsp . lactis CUL34 ( NCIMB 30172 ) plus 50 mg vitamin C or a placebo daily for 6 months . Results : Significant reductions in the incidence rate of upper respiratory tract infection ( URTI ; 33 % , P=0.002 ) , the number of days with URTI symptoms ( mean difference : −21.0 , 95 % confidence interval (CI):−35.9 , −6.0 , P=0.006 ) and the incidence rate of absence from preschool ( 30 % , P=0.007 ) were observed in the active group compared with the placebo . The number of days of use of antibiotics , painkillers , cough medicine or nasal sprays was lower in the active group and reached significance for use of cough medicine ( mean difference : −6.6 , 95 % CI : −12.9 , −0.3 , P=0.040 ) . No significant differences were observed in the incidence rate ratio or duration of lower respiratory tract infection or in the levels of plasma cytokines , salivary immunoglobulin A or urinary metabolites . Conclusions : Supplementation with a probiotic/vitamin C combination may be beneficial in the prevention and management of URTIs Background and aims : The purpose of this study was to investigate the efficacy of a synbiotic supplementation in reducing common winter diseases  in children . Methods : A r and omized , double-blind , placebo-controlled , multicentre study was conducted in young school-age children ( 3—7 years old ) during a winter period . Participants were otherwise healthy children who suffered from at least three episodes of ear , nose and throat ( ENT ) , respiratory tract or gastrointestinal illness during the previous winter . They were supplemented daily with either a synbiotic preparation ( Lactobacillus helveticus R0052 , Bifidobacterium infantis R0033 , Bifidobacterium bifidum R0071 , and fructooligosaccharide ) or a matched placebo for 3 months . Over this period , all emergent health episodes of any type were recorded by parents in a diary . They were checked by investigators at regular monthly visits . The main study outcome was the percentage of children free of any episode during the study course . Results : We r and omized 135 children ( mean age : 4.1±1.0 years ) to the synbiotic group ( n = 62 ) or placebo ( n = 73 ) group . At least one illness episode was reported in 32 children in the synbiotic group and 50 in the placebo group ( 51.6 % versus 68.5 % ) . This corresponded to a significant 25 % relative risk reduction ( 95 % CI 0.6—44.3 % ; p = 0.045 ) . This difference was due to a decrease in the number of children who suffered from at least one ENT , respiratory tract or gastrointestinal disorder ( 50.0 % with synbiotic versus 67.1 % with placebo ; p = 0.044 ) . At least one sickness school day loss was noted in 25.8 % of children with the synbiotic as compared with 42.5 % with placebo ( p = 0.043 ) . No treatment related side effects were detected in either group . Conclusions : This study suggests that a 3-month supplementation with this synbiotic preparation  can decrease the risk of occurrence of common infectious diseases in children and limits the risk of school day loss B 
    Output:
    
Probiotics may prevent AOM in children not prone to AOM , but the inconsistency of the subgroup analyses suggests caution in interpreting these results .
Probiotics decreased the proportion of children taking antibiotics for any infection .
The proportion of children experiencing adverse events did not differ between the probiotic and comparator groups .