human
***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: BACKGROUND Therapy with antibiotics influences recovery only in selected cases of COPD exacerbations . We evaluated the efficacy and safety of procalcitonin guidance compared to st and ard therapy with antibiotic prescriptions in patients experiencing exacerbations of COPD . METHODS A total of 208 consecutive patients requiring hospitalization for COPD exacerbation were r and omized at the index exacerbation to procalcitonin-guided or st and ard antibiotic therapy . Patients receiving procalcitonin-guided therapy were treated with antibiotics according to serum procalcitonin levels ; st and ard-therapy patients received antibiotics according to the attending physician . The primary outcome was the antibiotic exposure at the index exacerbation and the subsequent antibiotic requirement for COPD exacerbation within 6 months . Secondary outcomes were clinical recovery , symptom scores , length of hospitalization , ICU stay , death , lung function , exacerbation rate , and time to next exacerbation . RESULTS At the index exacerbation , procalcitonin guidance reduced antibiotic prescription ( 40 % vs 72 % , respectively ; p < 0.0001 ) and antibiotic exposure ( relative risk [ RR ] , 0.56 ; 95 % confidence interval [ CI ] , 0.43 to 0.73 ; p < 0.0001 ) compared to st and ard therapy . Moreover , procalcitonin guidance at the index exacerbation allowed a significant sustained reduction in total antibiotic exposure for up to 6 months ( RR , 0.76 ; 95 % CI , 0.64 to 0.92 ; p = 0.004 ) . Clinical outcome and improvement in FEV(1 ) at 14 days and 6 months did not differ between groups . Within 6 months , the exacerbation rate ( 0.62 vs 0.64 , respectively ) , the rehospitalization rate ( 0.21 vs 0.24 , respectively ) , and mean ( + /- SD ) time to the next exacerbation ( 70.0 + /- 46.1 vs 70.4 + /- 51.9 days , respectively ; p = 0.523 ) were similar in both groups . CONCLUSIONS Procalcitonin guidance for exacerbations of COPD offers a sustained advantage over st and ard therapy in reducing antibiotic use for up to 6 months with a number-needed-to-treat of 3 The Glasgow coma score ( GCS ) during days 1 - 6 after cardiac arrest was used to predict neurological outcome in 360 resuscitated victims of out-of-hospital cardiac arrest . A predictive rule based on the best GCS of 216 patients resuscitated in 1983 - 84 ( prediction group ) was constructed , and its predictive power was tested on 133 patients treated in 1985 ( test group ) .  Neurological outcome was correctly predicted 2 days after cardiac arrest in 80 % of the prediction group , with a best GCS of 10 or above and 4 or below as cutoff points . For patients with a best GCS of 5 - 9 , prediction of outcome was possible 6 days after cardiac arrest , with a best GCS of 8 during the first 6 days as the single cutoff point . The rule was then vali date d in the test group : the sensitivity was 96 % ; the specificity 86 % ; the negative predictive value 97 % ; and the positive predictive value 77 % . These data suggest that this simple GCS-based rule can be helpful in predicting outcome in patients resuscitated after out-of-hospital cardiac arrest , but confirmation of these data is required in a prospect i ve study in a larger number of patients ABSTRACT A r and omized , double-blind , double-dummy trial was performed comparing 200 mg of cefditoren-pivoxil twice daily for 5 days versus st and ard cefuroxime-axetil treatment ( 250 mg twice daily for 10 days ) of Anthonisen type I or II acute exacerbations of chronic bronchitis . The modified intention-to-treat population included 541 patients . Patients were assessed during therapy , at the end of therapy ( visit 3 ; primary evaluation time point ) , and at follow-up . Clinical success was obtained in 79.9 % of the 264 patients included in the cefditoren-pivoxil group and in 82.7 % of the 277 patients in the cefuroxime-axetil group ( treatment difference , 95 % confidence interval [ CI ] : −2.8 , −9.7 to 3.6 % ) . Treatment clinical effects were more clearly seen in sputum signs ( decreasing volume and purulence from approximately 80 % to approximately 10 % of the patients ) . At the end of treatment , exploratory analysis of the per-pathogen bacteriological response showed 72.8 % ( of 103 isolates ) in the cefditoren-pivoxil arm versus 67.0 % ( of 94 isolates ) in the cefuroxime-axetil group ( treatment difference ; 95 % CI : 5.8 , −7.0 to 18.6 % ) . Globally , the per-pathogen bacteriological response correlated well with clinical success : 83.5 % of 164 baseline isolates from patients with a clinical success were eradicated or presumably eradicated , in contrast to only 3 % of 33 isolates from patients with a clinical failure . Clinical success in patients infected with Haemophilus influenzae , the most frequent isolate , was 84 % ( of 50 ) and 82.5 % ( of 40 ) ( treatment difference ; 95 % CI : 1.5 , −14 to 17 % ) in the cefditoren-pivoxil versus the cefuroxime-axetil group . Although this study does not prove that either drug is better than a placebo , cefditoren-pivoxil and the st and ard 10-day cefuroxime-axetil course had similar point estimates of success in acute exacerbations of chronic bronchitis Factors determining in-hospital mortality and long-term survival of patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease ( AE COPD ) are not precisely understood . The aim of the present study was to assess the parameters related to in-hospital mortality and long-term survival after hospitalisation of patients with AE COPD . Clinical and epidemiological parameters on admission in 205 consecutive patients hospitalised with AE COPD were prospect ively assessed . Patients were followed-up for 3 yrs . Factors determining short- and long-term mortality were analysed . In total , 17 patients ( 8.3 % ) died in hospital . In-hospital mortality was significantly associated with lower arterial oxygen tension ( Pa , O2 ) , higher carbon dioxide arterial tension , lower arterial oxygen saturation and longer hospital stay . The overall 6-month mortality rate was 24 % , with 1- , 2- and 3-yr mortality rates of 33 % , 39 % and 49 % , respectively . Cox regression analysis revealed that long-term mortality was associated with longer disease duration ( relative risk ( RR ) = 1.158 ) , lower albumin ( RR = 0.411 ) , lower Pa , O2 ( RR = 0.871 ) and lower body mass index ( RR = 0.830 ) . When the model was run for the time elapsed since first hospitalisation , it also appeared as statistically significant ( RR = 1.195 ) . These findings show that patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease have poor short- and long-term survival . Prediction of survival status may be enhanced by considering arterial oxygen tension , albumin , body mass index , disease duration and time elapsed since the first hospitalisation Summary In a double-blind trial of  ampicillin and tetracycline  in chronic bronchitics with purulent sputum , 44 patients received ampicillin 1 g.  per day for five days and 43 patients received tetracycline 1 g.  per day for five days . Purulence of sputum was lessened in 37 ( 84 per cent . ) of the 44 ampicillin patients and in 35 ( 81 per cent . ) of the 43  tetracycline  patients ; but whereas the purulence was completely eliminated in only 19 ( 43 per cent . ) of the tetracycline patients , it was eliminated completely in 28 ( 64 per cent . ) of the ampicillin patients . H. influenz˦ , Strep . pneumoni˦ and other potential pathogens disappeared from the sputum of patients in both series with approximately equal frequency The optimal duration of antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease ( AE COPD ) is unknown . This study compared the outcome of treatment for 3 vs. 10 days with amoxycillin-clavulanic acid of hospitalised patients with AE COPD who had improved substantially after initial therapy for 3 days . Between November 2000 and December 2003 , 56 patients with AE COPD were enrolled in the study . Unfortunately , because of the low inclusion rate , the trial was discontinued prematurely . Patients were treated with oral or intravenous amoxycillin-clavulanic acid . Patients who showed improvement after 72 h were r and omised to receive oral amoxycillin-clavulanic acid 625 mg or placebo , four times daily for 7 days . The primary outcome measure of the study was clinical cure after 3 weeks and 3 months . Of 46 patients included in the final analysis , 21 were in the 3-day treatment group and 25 were in the 10-day treatment group . After 3 weeks , 16 ( 76 % ) of 21 patients in the 3-day treatment group were cured , compared with 20 ( 80 % ) of 25 in the 10-day treatment group ( difference -3.8 % ; 95 % CI -28 to 20 ) . After 3 months , 13 ( 62 % ) of 21 patients were cured , compared with 14 ( 56 % ) of 25 ( difference 5.9 % ; 95 % CI -23 to 34 ) . Microbiological success , symptom recovery , the use of corticosteroids , the duration of oxygen therapy and the length of hospital stay were comparable for both treatment groups . It was concluded that 3-day treatment with amoxycillin-clavulanic acid can be a safe and effective alternative to the st and ard 10-day treatment for hospitalised patients with AE COPD who have improved after initial therapy for 3 days ABSTRACT Background : Clarithromycin is commonly dosed for 7 or more days in patients with acute bacterial exacerbation of chronic bronchitis ( ABECB ) . Studies with other antibiotics have shown equivalent efficacy , reduced/similar frequency of adverse events , improved adherence and patient satisfaction , and lower treatment costs with a shorter treatment course . Patients and methods : The study population was derived from two multicenter , r and omized , double-blind ( North America)/single-blind ( France ) comparative trials in which out patients at least 35 years old with a presumptive diagnosis of obstructive ABECB were r and omized to receive clarithromycin extended-release ( ER ) 1000 mg once daily for 5 days or a comparator agent – clarithromycin immediate-release ( IR ) 500 mg twice daily for 7 days ( in North America ) or telithromycin 800 mg once daily for 5 days ( in France ) . Results : A total of 818 patients were r and omized ( 411 to  clarithromycin  ER and 407 to a comparator agent ) . The clinical cure rate in clinical ly evaluable patients at the follow-up visit was 90 % each for the clarithromycin ER group ( 318/353 ) and the comparator group ( 318/355 ) . The patient bacteriological cure rate and the overall target pathogen eradication rate in clinical ly and bacteriologically evaluable patients were each 92 % for the clarithromycin ER group ( 155/168 and 189/205 , respectively ) and 93 % for the comparator group ( 147/158 and 183/197 , respectively ) at the follow-up visit . The study drugs were generally well tolerated , with < 2 % of patients discontinuing their treatment prematurely due to a drug-related adverse event . The incidence of drug-related adverse events was 18 % ( 73/411 ) in the clarithromycin ER group and 24 % ( 97/407 ) in the comparator group . Clarithromycin ER-treated patients reported statistically significantly fewer episodes of abdominal pain than did patients treated with a comparator agent ( 0.2 % vs. 1.7 % , respectively ; p = 0.037 ) . This combined analysis is limited by differing blinding methods , comparator agents , and their duration of administration . Furthermore , many patients were excluded from the clinical ly and bacteriologically evaluable group due to lack of a pretreatment target pathogen . Conclusion : A once daily , 5‑day clarithromycin ER regimen appears to be a suitable choice for treating patients with ABECB Community-acquired pneumonia ( CAP ) remains a major cause of mortality . The aetiology of CAP has rarely been identified as a mortality risk factor . A prospect i ve study was conducted to assess the pro 
    Output:
    
agent
***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: BACKGROUND Therapy with antibiotics influences recovery only in selected cases of COPD exacerbations . We evaluated the efficacy and safety of procalcitonin guidance compared to st and ard therapy with antibiotic prescriptions in patients experiencing exacerbations of COPD . METHODS A total of 208 consecutive patients requiring hospitalization for COPD exacerbation were r and omized at the index exacerbation to procalcitonin-guided or st and ard antibiotic therapy . Patients receiving procalcitonin-guided therapy were treated with antibiotics according to serum procalcitonin levels ; st and ard-therapy patients received antibiotics according to the attending physician . The primary outcome was the antibiotic exposure at the index exacerbation and the subsequent antibiotic requirement for COPD exacerbation within 6 months . Secondary outcomes were clinical recovery , symptom scores , length of hospitalization , ICU stay , death , lung function , exacerbation rate , and time to next exacerbation . RESULTS At the index exacerbation , procalcitonin guidance reduced antibiotic prescription ( 40 % vs 72 % , respectively ; p < 0.0001 ) and antibiotic exposure ( relative risk [ RR ] , 0.56 ; 95 % confidence interval [ CI ] , 0.43 to 0.73 ; p < 0.0001 ) compared to st and ard therapy . Moreover , procalcitonin guidance at the index exacerbation allowed a significant sustained reduction in total antibiotic exposure for up to 6 months ( RR , 0.76 ; 95 % CI , 0.64 to 0.92 ; p = 0.004 ) . Clinical outcome and improvement in FEV(1 ) at 14 days and 6 months did not differ between groups . Within 6 months , the exacerbation rate ( 0.62 vs 0.64 , respectively ) , the rehospitalization rate ( 0.21 vs 0.24 , respectively ) , and mean ( + /- SD ) time to the next exacerbation ( 70.0 + /- 46.1 vs 70.4 + /- 51.9 days , respectively ; p = 0.523 ) were similar in both groups . CONCLUSIONS Procalcitonin guidance for exacerbations of COPD offers a sustained advantage over st and ard therapy in reducing antibiotic use for up to 6 months with a number-needed-to-treat of 3 The Glasgow coma score ( GCS ) during days 1 - 6 after cardiac arrest was used to predict neurological outcome in 360 resuscitated victims of out-of-hospital cardiac arrest . A predictive rule based on the best GCS of 216 patients resuscitated in 1983 - 84 ( prediction group ) was constructed , and its predictive power was tested on 133 patients treated in 1985 ( test group ) .  Neurological outcome was correctly predicted 2 days after cardiac arrest in 80 % of the prediction group , with a best GCS of 10 or above and 4 or below as cutoff points . For patients with a best GCS of 5 - 9 , prediction of outcome was possible 6 days after cardiac arrest , with a best GCS of 8 during the first 6 days as the single cutoff point . The rule was then vali date d in the test group : the sensitivity was 96 % ; the specificity 86 % ; the negative predictive value 97 % ; and the positive predictive value 77 % . These data suggest that this simple GCS-based rule can be helpful in predicting outcome in patients resuscitated after out-of-hospital cardiac arrest , but confirmation of these data is required in a prospect i ve study in a larger number of patients ABSTRACT A r and omized , double-blind , double-dummy trial was performed comparing 200 mg of cefditoren-pivoxil twice daily for 5 days versus st and ard cefuroxime-axetil treatment ( 250 mg twice daily for 10 days ) of Anthonisen type I or II acute exacerbations of chronic bronchitis . The modified intention-to-treat population included 541 patients . Patients were assessed during therapy , at the end of therapy ( visit 3 ; primary evaluation time point ) , and at follow-up . Clinical success was obtained in 79.9 % of the 264 patients included in the cefditoren-pivoxil group and in 82.7 % of the 277 patients in the cefuroxime-axetil group ( treatment difference , 95 % confidence interval [ CI ] : −2.8 , −9.7 to 3.6 % ) . Treatment clinical effects were more clearly seen in sputum signs ( decreasing volume and purulence from approximately 80 % to approximately 10 % of the patients ) . At the end of treatment , exploratory analysis of the per-pathogen bacteriological response showed 72.8 % ( of 103 isolates ) in the cefditoren-pivoxil arm versus 67.0 % ( of 94 isolates ) in the cefuroxime-axetil group ( treatment difference ; 95 % CI : 5.8 , −7.0 to 18.6 % ) . Globally , the per-pathogen bacteriological response correlated well with clinical success : 83.5 % of 164 baseline isolates from patients with a clinical success were eradicated or presumably eradicated , in contrast to only 3 % of 33 isolates from patients with a clinical failure . Clinical success in patients infected with Haemophilus influenzae , the most frequent isolate , was 84 % ( of 50 ) and 82.5 % ( of 40 ) ( treatment difference ; 95 % CI : 1.5 , −14 to 17 % ) in the cefditoren-pivoxil versus the cefuroxime-axetil group . Although this study does not prove that either drug is better than a placebo , cefditoren-pivoxil and the st and ard 10-day cefuroxime-axetil course had similar point estimates of success in acute exacerbations of chronic bronchitis Factors determining in-hospital mortality and long-term survival of patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease ( AE COPD ) are not precisely understood . The aim of the present study was to assess the parameters related to in-hospital mortality and long-term survival after hospitalisation of patients with AE COPD . Clinical and epidemiological parameters on admission in 205 consecutive patients hospitalised with AE COPD were prospect ively assessed . Patients were followed-up for 3 yrs . Factors determining short- and long-term mortality were analysed . In total , 17 patients ( 8.3 % ) died in hospital . In-hospital mortality was significantly associated with lower arterial oxygen tension ( Pa , O2 ) , higher carbon dioxide arterial tension , lower arterial oxygen saturation and longer hospital stay . The overall 6-month mortality rate was 24 % , with 1- , 2- and 3-yr mortality rates of 33 % , 39 % and 49 % , respectively . Cox regression analysis revealed that long-term mortality was associated with longer disease duration ( relative risk ( RR ) = 1.158 ) , lower albumin ( RR = 0.411 ) , lower Pa , O2 ( RR = 0.871 ) and lower body mass index ( RR = 0.830 ) . When the model was run for the time elapsed since first hospitalisation , it also appeared as statistically significant ( RR = 1.195 ) . These findings show that patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease have poor short- and long-term survival . Prediction of survival status may be enhanced by considering arterial oxygen tension , albumin , body mass index , disease duration and time elapsed since the first hospitalisation Summary In a double-blind trial of  ampicillin and tetracycline  in chronic bronchitics with purulent sputum , 44 patients received ampicillin 1 g.  per day for five days and 43 patients received tetracycline 1 g.  per day for five days . Purulence of sputum was lessened in 37 ( 84 per cent . ) of the 44 ampicillin patients and in 35 ( 81 per cent . ) of the 43  tetracycline  patients ; but whereas the purulence was completely eliminated in only 19 ( 43 per cent . ) of the tetracycline patients , it was eliminated completely in 28 ( 64 per cent . ) of the ampicillin patients . H. influenz˦ , Strep . pneumoni˦ and other potential pathogens disappeared from the sputum of patients in both series with approximately equal frequency The optimal duration of antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease ( AE COPD ) is unknown . This study compared the outcome of treatment for 3 vs. 10 days with amoxycillin-clavulanic acid of hospitalised patients with AE COPD who had improved substantially after initial therapy for 3 days . Between November 2000 and December 2003 , 56 patients with AE COPD were enrolled in the study . Unfortunately , because of the low inclusion rate , the trial was discontinued prematurely . Patients were treated with oral or intravenous amoxycillin-clavulanic acid . Patients who showed improvement after 72 h were r and omised to receive oral amoxycillin-clavulanic acid 625 mg or placebo , four times daily for 7 days . The primary outcome measure of the study was clinical cure after 3 weeks and 3 months . Of 46 patients included in the final analysis , 21 were in the 3-day treatment group and 25 were in the 10-day treatment group . After 3 weeks , 16 ( 76 % ) of 21 patients in the 3-day treatment group were cured , compared with 20 ( 80 % ) of 25 in the 10-day treatment group ( difference -3.8 % ; 95 % CI -28 to 20 ) . After 3 months , 13 ( 62 % ) of 21 patients were cured , compared with 14 ( 56 % ) of 25 ( difference 5.9 % ; 95 % CI -23 to 34 ) . Microbiological success , symptom recovery , the use of corticosteroids , the duration of oxygen therapy and the length of hospital stay were comparable for both treatment groups . It was concluded that 3-day treatment with amoxycillin-clavulanic acid can be a safe and effective alternative to the st and ard 10-day treatment for hospitalised patients with AE COPD who have improved after initial therapy for 3 days ABSTRACT Background : Clarithromycin is commonly dosed for 7 or more days in patients with acute bacterial exacerbation of chronic bronchitis ( ABECB ) . Studies with other antibiotics have shown equivalent efficacy , reduced/similar frequency of adverse events , improved adherence and patient satisfaction , and lower treatment costs with a shorter treatment course . Patients and methods : The study population was derived from two multicenter , r and omized , double-blind ( North America)/single-blind ( France ) comparative trials in which out patients at least 35 years old with a presumptive diagnosis of obstructive ABECB were r and omized to receive clarithromycin extended-release ( ER ) 1000 mg once daily for 5 days or a comparator agent – clarithromycin immediate-release ( IR ) 500 mg twice daily for 7 days ( in North America ) or telithromycin 800 mg once daily for 5 days ( in France ) . Results : A total of 818 patients were r and omized ( 411 to  clarithromycin  ER and 407 to a comparator agent ) . The clinical cure rate in clinical ly evaluable patients at the follow-up visit was 90 % each for the clarithromycin ER group ( 318/353 ) and the comparator group ( 318/355 ) . The patient bacteriological cure rate and the overall target pathogen eradication rate in clinical ly and bacteriologically evaluable patients were each 92 % for the clarithromycin ER group ( 155/168 and 189/205 , respectively ) and 93 % for the comparator group ( 147/158 and 183/197 , respectively ) at the follow-up visit . The study drugs were generally well tolerated , with < 2 % of patients discontinuing their treatment prematurely due to a drug-related adverse event . The incidence of drug-related adverse events was 18 % ( 73/411 ) in the clarithromycin ER group and 24 % ( 97/407 ) in the comparator group . Clarithromycin ER-treated patients reported statistically significantly fewer episodes of abdominal pain than did patients treated with a comparator agent ( 0.2 % vs. 1.7 % , respectively ; p = 0.037 ) . This combined analysis is limited by differing blinding methods , comparator agents , and their duration of administration . Furthermore , many patients were excluded from the clinical ly and bacteriologically evaluable group due to lack of a pretreatment target pathogen . Conclusion : A once daily , 5‑day clarithromycin ER regimen appears to be a suitable choice for treating patients with ABECB Community-acquired pneumonia ( CAP ) remains a major cause of mortality . The aetiology of CAP has rarely been identified as a mortality risk factor . A prospect i ve study was conducted to assess the pro 
    Output:
    