***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: Context Eradication rates for Helicobacter pylori infection are decreasing worldwide because of increasing antimicro-bial resistance . Contribution This double-blind trial r and omly assigned 300 adults with dyspepsia or peptic ulcers to a 10-day sequential regimen ( pantoprazole , amoxicillin , and placebo taken for 5 days followed by pantoprazole , clarithromycin , and tinidazole taken for 5 days ) or st and ard 10-day therapy ( pantoprazole , clarithromycin , and amoxicillin ) . The eradication rate of H. pylori infection was greater with the sequential regimen ( 89 % ) than with the st and ard treatment ( 77 % ) . Approximately 5 % of patients in each group had epigastric pain and 3 % to 5 % had mild diarrhea . Implication Sequential therapy  eradicates H. pylori infection more often than does st and ard therapy . The Editors Helicobacter pylori infection causes peptic ulcers , gastric mucosaassociated lymphoid tissue lymphoma , and gastric cancer ( 1 ) . St and ard treatments for H. pylori infection that have been endorsed by U.S. and European authorities rely on clarithromycin or metronidazole in conjunction with other antibiotics and acid inhibitors ( 2 , 3 ) . The prevalence of clarithromycin and metronidazole resistance has increased substantially in recent years , and there has been a corresponding decrease in the eradication rate for H. pylori infection ( 4 ) . Eradication rates in most western countries have declined to unacceptable levels . Eradication therapy fails in approximately 1 in 5 patients ( 5 ) . A simple , short treatment regimen that would return eradication levels to those seen at the advent of H. pylori treatment is urgently needed ( 5 ) . Such a regimen should have high efficacy against clarithromycin-resistant and metronidazole-resistant strains of H. pylori because these strains are increasingly encountered in routine clinical practice . Novel 10-day sequential therapy consisting of 5-day dual therapy ( proton-pump inhibitor plus amoxicillin ) followed by 5-day triple therapy ( proton-pump inhibitor , clarithromycin , and tinidazole ) has had good eradication success in unblinded trials in elderly and pediatric patients ( 68 ) . However , no double-blind , controlled trials using conventional therapy have been reported , and the effect of clarithromycin and metronidazole resistance on the outcome of sequential therapy has not been studied prospect ively . The aim of this study was to compare a 10-day sequential treatment regimen for H. pylori infection with st and  ard  10-day triple therapy in a r and omized , controlled trial . Secondary objectives were to determine the efficacy of the treatment regimen in patients with resistant strains of H. pylori , to assess treatment adherence , and to evaluate side effects . Methods Design Overview This was a prospect i ve , double-blind , controlled study with a parallel-group design . At baseline , patients were evaluated for inclusion and exclusion criteria and provided written informed consent . Patients were then r and omly assigned to a treatment group and had follow-up evaluations to assess the eradication rate of H. pylori infection , treatment adherence , and side effects . The study was performed according to good clinical practice and the Declaration of Helsinki . The ethics committees at the 2 participating centers approved the study . The consent form indicated that patients would be r and omly assigned to treatment that was the current st and ard or a new therapy that might have higher eradication rates . Patients were told that eradication failure was possible with any therapy regimen . All patients with eradication failure were offered a rescue therapy on the basis of the results of sensitivity testing . Setting and Participants Between September 2003 and April 2006 , consecutive patients with dyspepsia who were at least 18 years of age , who had never received treatment for H. pylori infection , and who had been referred to our hospitals ( Bologna , Italy , and Rome , Italy ) for a gastroenterology consultation were asked to participate in the study . No special recruitment techniques ( such as advertisements or letters sent to primary care physicians ) were used . Exclusion criteria were previous treatment for H. pylori infection ; use of proton-pump inhibitors , H2-receptor antagonists , bismuth preparations , or antibiotics  in the previous 2 weeks ; concomitant use of anticoagulants  or  ketoconazole  ( because of potential interaction with the nonsteroidal anti-inflammatory drugs ) and glucocorticoids ( because of association with ulcer disease ) ; the ZollingerEllison syndrome ; previous surgery of the esophagus or upper gastrointestinal tract ( except appendectomy , polypectomy , or cholecystectomy ) ; severe or unstable cardiovascular , pulmonary , or endocrine disease ; clinical ly significant renal or hepatic disease or dysfunction ; hematologic disorders ; any other clinical ly significant medical condition that could increase risk ; malignant disease of any kind except for successfully treated skin cancer ( basal- or squamous-cell carcinoma ) during the previous 5 years ; Barrett esophagus or high- grade dysplasia ; drug , alcohol , or medication abuse within the past year ; severe psychiatric or neurologic disorders ; and pregnancy or lactation , as well as sexually active women of child-bearing years who were not willing to practice medically acceptable contraception ( oral or injectable contraceptives , implantable or mechanical intrauterine or vaginal devices , or vasectomy for the partner ) for the study duration . R and omization and Interventions Patient allocation was determined with a r and om-number chart that was concealed from investigators and patients by using numbered blister packs of the study medication that corresponded to the r and om-number chart . A computer-generated r and omization chart was used to determine allocation , which was stratified according to center by using a block design and a block size of 4 . Allocation was concealed with an opaque envelope , which contained a number that corresponded to the numbered blister packs . The envelope was opened when the patient met the inclusion criteria and provided informed consent . Patients and investigators were blinded to treatment group . Patients were r and omly allocated to receive a 10-day sequential regimen ( 40 mg of pantoprazole , 1 g of amoxicillin , and placebo , each administered twice daily for the first 5 days , followed by 40 mg of pantoprazole , 500 mg of clarithromycin , and 500 mg of tinidazole , each administered twice daily for the remaining 5 days ) ; or st and ard therapy ( 40 mg of pantoprazole , 500 mg of clarithromycin , and 1 g of amoxicillin , each administered twice daily for 10 days ) . Medications were contained in individual blisters in the package . A placebo that was identical in color and shape to the clarithromycin capsule was administered during the first 5 days of sequential therapy to maintain blinding . This ensured that all patients took 3 medications twice a day for 10 days . Measurements and Outcomes The primary outcome of the study was eradication of H. pylori infection . Secondary outcomes were to determine the efficacy of sequential treatment against clarithromycin-resistant strains of H. pylori , to assess adherence to therapy , and to determine the frequency of self-reported side effects . 13C-Urea Breath Test Urea breath tests were done after an overnight fast . A baseline breath sample was obtained , and 75 mg of 13C-urea with citric acid ( 1.5 g ) was administered as an aqueous solution . Another breath sample was collected 30 minutes after the test solution was administered . The results of the test were considered positive if the difference between the baseline sample and the 30-minute sample exceeded 4.5 parts per 1000 of 13CO2 . All breath sample s were analyzed in Bologna by using a single gas isotope ratio mass spectrometer ( Finnigan , Bremen , Germany ) . The accuracy of the urea breath test was previously vali date d in our laboratory . We reported sensitivity and specificity values of 94.7 % and 95.7 % , respectively ( 9 ) . Endoscopy All patients with positive results on the urea breath test had upper endoscopy , and 5 biopsy specimens were obtained during the procedure . Two specimens were taken from the antrum and 2 were taken from the corpus for histologic evaluation . The specimens were stained with hematoxylin and eosin and Giemsa stains , and gastritis was scored by using the up date d Sydney System ( 10 ) . The pathologist who performed the histologic examination was blinded to the results of all other tests . One biopsy specimen was obtained from the antrum for the rapid urease test ( Campylobacter pylori test , Yamanouchi Pharma S.p . A , Corrugate , Milan , Italy ) . Two additional biopsy sample s from the antrum were collected for bacterial culture and susceptibility testing . We performed cultures without knowing the other test results . For this purpose , biopsy specimens were sent to a single microbiological laboratory in Bologna within 24 hours and were stored at 70C . Isolated strains were tested for primary clarithromycin  and  metronidazole resistance by using an agar dilution method , which was defined as a minimal inhibitory concentration greater than 1 mg/L and greater than 8 mg/L for clarithromycin and metronidazole , respectively ( 11 ) . Strains were classified as having isolated resistance to clarithromycin  or metronidazole if the organisms were only resistant to 1 antibiotic . Dual resistance was defined as resistance to clarithromycin and metronidazole . At baseline , patients were classified as having H. pylori infection  if the results on the urea breath test were positive and if the results on at least 2 of the following 3 tests were positive : rapid urease test , histologic examination , and culture . An expert panel recommended these criteria for use in clinical trials of H. pylori infection ( 12 ) . Follow-up Procedures Treatment Adherence and Side Effects Patients were asked to return at the completion of therapy for a physical evaluation and to assess adherence to therapy and side effects . We first AIM To evaluate susceptibility of Helicobacter pylori to amoxicillin and clarithromycin in end-stage renal disease ( ESRD ) patients and non-uremic controls . METHODS The subjects with dyspeptic complaints were 33 ESRD patients and 46 age- and sex-matched non-uremic controls who exhibited H pylori on antral biopsy specimens . The two groups were age and sex matched . The H pylori strains ' pattern of susceptibility to amoxicillin and clarithromycin was investigated with the agar dilution technique . RESULTS None of the H pylori strains from either group showed resistance to amoxicillin with the agar dilution method . Twelve ( 36.4 % ) of the ESRD group strains and 7 ( 15.2 % ) of the control group strains showed resistance to clarithromycin  , and this difference was statistically significant ( P<0.05 ) . CONCLUSION Resistance to amoxicillin  does not appear to be an important problem in H pylori-infected ESRD and non-uremic patients in our region . In contrast , the rates of resistance to clarithromycin  are high , particularly in the ESRD population Helicobacter pylori is the primary cause of peptic ulcer disease and an etiologic agent in the development of gastric cancer . H. pylori infection is curable with regimens of multiple antimicrobial agents , and antimicrobial resistance is a leading cause of treatment failure . The Helicobacter pylori Antimicrobial Resistance Monitoring Program ( HARP ) is a prospect i ve , multicenter U.S. network that tracks national incidence rates of H. pylori antimicrobial resistance . Of 347 clinical H. pylori isolates collected from December 1998 through 2002 , 101 ( 29.1 % ) were resistant to one antimicrobial agent , and 17 ( 5 % ) were resistant to two or more antimicrobial agents . Eighty-seven ( 25.1 % ) isolates were resistant to  metronidazole  , 45 ( 12.9 % ) to  clarithromycin  , and 3 ( 0.9 % ) to  amoxicillin .  On multivariate analysis , black race was the only significant risk factor ( p < 0.01 , hazard ratio 2.04 ) for infection with a resistant H. pylori strain . Formulating pretreatment screening strategies or providing alternative therapeutic regimens for high-risk population s may be important for future clinical practice BACKGROUND Helicobacter pylori is associated with benign and malignant diseases of the upper gastrointestinal tract , and increasing antibiotic resistance has made alternative treatments necessary . Our aim was to assess the efficacy and safety of a new , single-capsule treatment versus the gold st and ard for H pylori eradication . METHODS We did a r and omised , open-label , non-inferiority , phase 3 trial in 39 sites in Europe , comparing the efficacy and safety of 10 days of quadruple therapy with omeprazole plus a single three-in-one capsule containing bismuth subcitrate potassium , metronidazole , and tetracycline 
    Output:
    
Primary antibiotic resistance against H. pylori in Turkey shows differences between geographical regions and population densities .
There is an increase in primary resistance rates to clarithromycin and metronidazole in different years .
The data are not sufficient for tetracycline , amoxicillin , and levofloxacin .
High  clarithromycin resistance rates were mostly detected in overpopulated cities like Ankara ( north ) , Izmir ( west ) , Istanbul ( west ) , and Bursa ( west )