***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: OBJECTIVE effects of Fosfomycin ( FOM ) nebulizer therapy were studied in patients with chronic sinusitis . METHODS about 28 patients with chronic sinusitis were administered 2 ml of FOM sodium ( 3 % w/v ) by nebulizer three times per week for 4 weeks . Levels of IL-1 beta , IL-6 , IL-8 , and TNF-alpha in nasal lavage were also measured before and at the end of treatment . RESULTS the overall efficacy of this treatment on the basis of both subjective and objective symptoms , was ' excellent ' for 28.6 % , ' good ' for 10.7 % , ' fair ' for 39.4 % , and yield ' no change ' for 21.4 % of the patients . Both IL-1 beta and IL-6 concentrations were significantly decreased after treatment . Although the IL-8 level did not significantly decrease , it seems to be related to the overall efficacy . TNF-alpha was not detected in all of the sample s. CONCLUSION FOM nebulization therapy is highly effective in treatment for chronic sinusitis , and efficacy may be due to an immunomodulatory mechanism , as well as its bactericidal effect BACKGROUND Chronic rhinosinusitis ( CRS ) is one of the most common chronic diseases . Recently , it has been suggested that an exaggerated immune response to fungi is crucial in the pathogenesis of the disease . On the basis of this hypothesis , intranasal treatment with amphotericin B should benefit patients with CRS . Data from 2 uncontrolled and 2 controlled trials are conflicting , however . OBJECTIVE To clarify the role of intranasal antifungal drugs in the treatment of CRS , we conducted a large , double-blind , placebo-controlled , multicenter study comparing the effectiveness of amphotericin B nasal lavages with placebo . METHODS A total of 116 r and omly selected patients with CRS were instructed to instill 25 mL amphotericin B ( 100 microg/mL ) or placebo to each nostril twice daily for 3 months . Primary outcomes included a reduction in total visual analog scale ( VAS ) score and nasal endoscopy score . Secondary outcome measures included peak nasal inspiratory flow , polyp score , quality of life ( Short Form-36 , Rhinosinusitis Outcome Measure-31 ) , and individual VAS scores . RESULTS Analysis was based on intention to treat and involved all patients r and omly assigned .  Mean VAS scores , Short Form-36 and Rhinosinusitis Outcome Measure-31 data , peak nasal inspiratory flow values , nasal endoscopy scores , and polyp scores were similar in both treatment groups at the time of r and omization , and no significant differences were observed after 13 weeks of treatment . CONCLUSION Amphotericin B nasal lavages in the described dosing and time schedule do not reduce clinical signs and symptoms in patients with CRS . CLINICAL IMPLICATION S Amphotericin B nasal lavages in the described dosing and time schedule are ineffective and therefore not advised in the treatment of patients with CRS Efficacy and safety of a new oral third generation Cephalosporin , Cefotiam Hexetil ( CTM ) 200 mg bid were compared with those of Cefixime ( CX ) 200 mg bid over 10 day duration of treatment . One hundred and twenty two ambulatory adults suffering from chronic sinusitis were r and omized by ENT specialists in this multicentre prospect i ve double blind , doubled dummy study . Sinusitis diagnosis evocated in front of fascial pain , purulent nasal discharge and /or obstruction was confirmed with sinus X-ray . Use of antibiotics or corticosteroids concomitantly or 15 days prior inclusion represented one of the major exclusion criterion . One hundred and seventy one patients were evaluated for efficacy analysis ( 62 and 59 respectively in CTM and CX groups ) . Regarding demographic data , clinical and radiological signs , the two population s were comparable at inclusion excepted for sex and weight ( female : 73 % in  CTM group versus 47 % in  CX group ) . The overall clinical success rate at the end of treatment ( cure+improvement ) was not significantly different between the two groups ( CTM : 82 % versus CX : 80 % ) . The incidence of adverse events was less frequent in the CTM group ( 14.5 % versus 19 % ) . In conclusion , CTM 200 mg bid is as efficacious and as well tolerated as CX 200 mg bid in the treatment of chronic sinusitis in adults BACKGROUND There is little scientific evidence to support the current practice of using oral glucocorticosteroids and antibiotics to treat patients with chronic rhinosinusitis and nasal polyps . OBJECTIVE We evaluated the effects of oral glucocorticoids and doxycycline on symptoms and objective clinical and biological parameters in patients with chronic rhinosinusitis and nasal polyps . METHODS In a double-blind , placebo-controlled , multicenter trial , we r and omly assigned 47 participants with bilateral nasal polyps to receive either methylprednisolone in decreasing doses ( 32 - 8 mg once daily ) , doxycycline ( 200 mg on the first day , followed by 100 mg once daily ) , or placebo for 20 days . Participants were followed for 12 weeks . Patients were assessed for nasal peak inspiratory flow and symptoms and by nasal endoscopy . Markers of inflammation such as eosinophilic cationic protein ( ECP ) , IL-5 , myeloperoxidase , matrix metalloproteinase 9 , and IgE were measured in nasal secretions . Concentrations of eosinophils , ECP , and soluble IL-5 receptor alpha were measured in peripheral blood sample s. RESULTS Methylprednisolone and doxycycline each significantly decreased nasal polyp size compared with placebo . The effect of methylprednisolone was maximal at week 3 and lasted until week 8 , whereas the effect of doxycycline was moderate but present for 12 weeks . Methylprednisolone significantly reduced levels of ECP , IL-5 , and IgE in nasal secretions , whereas doxycycline significantly reduced levels of myeloperoxidase , ECP , and matrix metalloproteinase 9 in nasal secretions . CONCLUSION This is the first double-blind , placebo-controlled study to show a significant effect of oral methylprednisolone and doxycycline on size of nasal polyps , nasal symptoms , and mucosal and systemic markers of inflammation BACKGROUND Recently , fungal elements were suspected to be the causative agent of chronic rhinosinusitis , and benefits of topical amphotericin B therapy have been reported . OBJECTIVE The effects of amphotericin B versus control nasal spray on chronic rhinosinusitis were compared in a double-blind , r and omized clinical trial . METHODS Patients with chronic rhinosinusitis were administered 200 microL per nostril amphotericin B ( 3 mg/mL ) or saline nasal spray 4 times daily over a period of 8 weeks . The response rate , defined as a 50 % reduction of pretreatment computed tomography score , was the primary outcome variable . Additional outcome variables included a symptom score , a quality of life score , and an endoscopy score . Before and after treatment , nasal lavages were pretreated with dithiothreitol and examined for fungal elements by PCR and st and ard culture techniques . RESULTS Seventy-eight patients were included , and 60 patients finished the study per protocol . In the control group , no positive response ( 0 of 32 ) was observed , and 2 of 28 patients responded in the amphotericin B group ( P>.2 ) . The symptom scores were distinctly worse after amphotericin B therapy ( P < .005 ) . The other parameters investigated did not differ remarkably between the treatment groups . CONCLUSION Nasal amphotericin B spray in the described dosing and time schedule is ineffective and deteriorates patient symptoms OBJECTIVES /HYPOTHESIS To examine the efficacy and tolerability of topical mupirocin for the management of surgically recalcitrant chronic rhinosinusitis ( CRS ) associated with Staphylococcus aureus infection . STUDY DESIGN Prospect i ve open-label pilot study . METHODS Patients with surgically recalcitrant CRS who had positive nasendoscopically guided cultures for Staphylococcus aureus were treated with twice daily nasal lavages containing 0.05 % Mupirocin and lactated ringers salts . The duration of treatment was 3 weeks . Patients were assessed before and after treatment in terms of nasendoscopic findings , microbiology results , and Sinonasal Outcome Test ( SNOT-20 ) and visual analogue scale question naires . RESULTS Fifteen of 16 patients had improved nasendoscopic findings after treatment . Twelve of 16 patients noted overall symptom improvement . Fifteen of 16 patients had negative swab results for Staphylococcus aureus after treatment . Only minimal adverse effects were experienced . CONCLUSIONS Nasal Lavage with 0.05 % Mupirocin may represent an effective and well tolerated alternative treatment for postsurgical recalcitrant CRS OBJECTIVES Conventional management of allergic fungal rhinosinusitis ( AFRS ) after surgery consists of the use of steroids to immunomodulate the body 's response to fungi . However , there are many side effects to prolonged steroid use , and some patients are unresponsive to st and ard treatment . The role of systemic antifungal drugs in AFRS is still largely unknown . This was a pilot study to evaluate the effectiveness of itraconazole , an oral antifungal drug , in the treatment of refractory AFRS . METHOD Thirty-two patients with AFRS who had had surgery and were refractory to prednisone , steroid , and amphotericin B nasal sprays were treated with itraconazole for at least 3 months . They were evaluated with pre- and posttreatment endoscopic examinations , serum immunoglobulin E ( IgE ) , and the 31-Item Rhinosinusitis Outcome Measure ( RSOM-31 ) question naires . Monthly liver function tests were done to monitor for the hepatic side effects of itraconazole . RESULTS Twelve cases had endoscopic improvement . Fifteen had no difference , and five had a worse endoscopic stage after 3 months . One patient had to stop treatment due to abnormal liver function tests . The mean pre- and posttreatment IgE levels were 581 microg/L and 766 microg/L , respectively . Subjectively , 9 patients ( 28 % ) reported a significant improvement , 9 ( 28 % ) had moderate improvements , and 14 ( 44 % ) reported little or no change . There was no correlation between the subjective and the endoscopic changes . CONCLUSION Itraconazole may be useful as an adjunct in the management of AFRS . However , more studies , including a prospect i ve r and omized clinical trial , are required to determine if itraconazole is effective in the management of AFRS BACKGROUND It has been suggested that an exaggerated immune response to fungi is crucial in the pathogenesis of chronic rhinosinusitis ( CRS ) . Based on this rationale , the use of topical antifungals ( amphotericin B ) has been advocated . Studies on its clinical effectiveness are , however , contradictory . OBJECTIVES To examine the effect of nasal antifungal treatment on secreted mediators in sample s of nasal lavage fluid from patients with CRS with or without nasal polyps ( NP ) . METHODS Part two of a prospect i ve double-blind , placebo-controlled multicenter clinical trial investigating the effect of 13 weeks of treatment with amphotericin B or placebo on the levels of pro-inflammatory cytokines , chemokines and growth factors ( i.e. , IL-1beta , IL-1RA , IL-2 , IL-2R , IL-3 , IL-4 , IL-5 , IL-6 , IL-7 , IL-8 , IL-10 , IL-12 ( p40/p70 subunits ) , IL-13 , IL-15 , IL-17 , TNF-alpha , IFN-alpha , IFN-gamma , G-CSF , GM-CSF , MIP-1alpha , MIP-1beta , IP-10 , MIG , eotaxin , RANTES , MCP-1 , MCP-2 , MCP-3 , VEGF , EGF , FGF-basic , HGF , Gro-alpha ) and albumin via a fluorescent enzyme immunoassay in nasal lavage specimens of CRS patients with or without NP . RESULTS Topical amphotericin B had no significant effect on the level of any of the tested pro-inflammatory cytokines , chemokines , and growth factors in CRS nasal lavage sample s. Treatment with placebo , however , increased the level of MIP-1alpha and MIP-1beta , which are mediators involved in wound healing . CONCLUSIONS Topical amphotericin B has no significant effect on activation markers of nasal inflammatory cells in chronic rhinosinusitis with or without nasal polyps BACKGROUND The treatment of acute , recurrent , and chronic sinusitis remains controversial because of the presence of a wide variety of aerobic and anaerobic bacteria in the sinuses . DESIGN This double-blind , r and omized trial compared cefaclor with amoxicillin in the treatment of acute , recurrent , and chronic maxillary sinusitis using clinical evaluation , roentgenography , and microbiologic evaluation of antral aspirates . SETTING Outpatient 
    Output:
    
CONCLUSION Based on the available evidence , oral antibacterial antibiotics and prolonged macrolide antibiotics are considered therapeutic options in the treatment of CRS while the use of topical antibacterial antibiotics , intravenous antibacterial antibiotics and oral , topical , or intravenous antifungals would be recommended against .