***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 Eradication of Helicobacter pylori infection plays a crucial role in the treatment of peptic ulcer .  Clarithromycin resistance is a major cause of treatment failure . This r and omized clinical trial aim ed at evaluating the efficacy of a clarithromycin versus gemifloxacin containing quadruple therapy regimen in eradication of H.pylori infection . METHODS In this r and omized double blind clinical trial ( RCT 2012102011054N2 ) , a total of 120 patients were r and omized to two groups of 60 patients each . Patients with proven H.pylori infection were consecutively assigned into two groups to receive OBAG or OBAC in gastroenterology clinic in Rasoul-e- Akram General Hospital in Tehran , Iran . The patients in the OBAG group received omeprazole ( 20 mg ) twice daily , bismuth subcitrate ( 240 mg ) twice daily , amoxicillin ( 1 gr ) twice daily , and gemifloxacin ( 320 mg ) once daily , and those in the OBAC group received omeprazole ( 20 mg ) twice daily , 240 mg of bismuth subcitrate twice daily , amoxicillin ( 1 gr ) twice daily , and clarithromycin ( 500 mg ) twice daily for 10 days . RESULTS Five patients from each group were excluded from the study because of poor compliance , so 110 patients completed the study . The intention-to-treat eradication rate was 61.6 % and 66.6 % for the OBAC and OBAG groups , respectively . According to the per protocol analysis , the success rates of eradication of H.pylori infection were 67.2 % and 72.7 % for OBAC and OBAG groups , respectively ( p=0.568 ) . CONCLUSION The results of this study suggest that gemifloxacin containing regimen is at least as effective as clarithromycin regimen ; hence , this new treatment could be considered as an alternative for the patients who can not tolerate clarithromycin BACKGROUND Aim was to evaluate the efficacy and tolerability of a moxifloxacin-containing second-line triple regimen in patients whose previous Helicobacter pylori eradication treatment failed . METHODS Prospect i ve multicentre study including patients in whom a triple therapy or a non-bismuth-quadruple-therapy failed .  Moxifloxacin ( 400 mg qd ) , amoxicillin ( 1 g bid ) , and esomeprazole ( 40 mg bid ) were prescribed for 14 days . Eradication was confirmed by (13)C-urea-breath-test . Compliance was determined through question ing and recovery of empty medication envelopes . RESULTS 250 patients were consecutively included ( mean age 48 ± 15 years , 11 % with ulcer ) . Previous ( failed ) therapy included : st and ard triple ( n = 179 ) , sequential ( n = 27 ) , and concomitant ( n = 44 ) ; 97 % of patients took all medications , 4 were lost to follow-up . Intention-to-treat and per- protocol eradication rates were 82.4 % ( 95 % CI , 77 - 87 % ) and 85.7 % ( 95 % CI , 81 - 90 % ) . Cure rates were similar independently of diagnosis ( ulcer , 77 % ; dyspepsia , 82 % ) and previous treatment ( st and ard triple , 83 % ; sequential , 89 % ; concomitant , 77 % ) . At multivariate analysis , only age was associated with eradication ( OR = 0.957 ; 95 % CI , 0.933 - 0.981 ) . Adverse events were reported in 25.2 % of patients : diarrhoea ( 9.6 % ) , abdominal pain ( 9.6 % ) , and nausea ( 9.2 % ) . CONCLUSION 14-day moxifloxacin-containing triple therapy is an effective and safe second-line strategy in patients whose previous st and ard triple therapy or non-bismuth quadruple ( sequential or concomitant ) therapy has failed , providing a simple alternative to bismuth quadruple regimen Abstract Objective : The objective of this study is to compare , in Greece , a region with > 20 % local resistance to clarithromycin , the efficacy rates of the concomitant versus the sequential H. pylori eradication therapy . Material s and methods : Our prospect i ve r and omized study included 364 patients with newly diagnosed H. pylori infection , r and omized to receive a 10-day concomitant or 10-day sequential therapy .  Treatment outcome was assessed by C13-urea breath test at least 4 weeks after therapy . Intention to treat ( ITT ) and per protocol ( PP ) analysis of the eradication rates were performed . Secondary end points included patient compliance and safety . Results : The concomitant therapy group achieved statistically significant higher eradication rates when compared with the sequential treatment group , both in the ITT and in the PP analysis ( 84.6 % versus 70.9 % , p = 0.002 , and 90.6 % versus 78.1 % , p = 0.001 , respectively ) , after adjusting for age , gender , smoking status , and the presence or not of ulcer and /or non-ulcer dyspepsia . Both groups displayed excellent compliance rates ( 99.5 % for the concomitant therapy group and 96.2 % for the sequential therapy group , p = 0.067 ) . Regarding treatment safety , major adverse events that led to the discontinuation of both regimens were few , with no statistical difference between the two groups ( 7.0 % for the concomitant therapy group and 2.9 % for the sequential therapy group ) . Conclusions : Concomitant therapy led to statistically significant higher eradication rates over sequential therapy . Both therapies showed excellent compliance and an acceptable safety profile . The 10-day quadruple concomitant scheme should be the adopted for first-line H. pylori eradication in Greece ABSTRACT Objective : The effectiveness of Helicobacter pylori therapies has declined with an increase in antibiotic resistance . To overcome this problem , the efficacy of tailored H. pylori eradication therapy based on antimicrobial susceptibility testing was compared with that of empirical second-line rescue regimens . Material and methods : Patients who had persistent H. pylori infection after the first eradication were recommended to undergo culture for determining the minimal inhibitory concentration ( MIC ) via gastroscopy , which increased the cost by 300 % . Fourteen-day esomeprazole , tripotassium dicitrate bismuthate , metronidazole and tetracycline ( EBMT ) therapy or esomeprazole , moxifloxacin and amoxicillin ( MEA ) therapy was performed according to the results of antibiotic susceptibility testing . In case of refusal to undergo culture , the participants were treated with either 14-day empirical EBMT or MEA regimen for second eradication after explaining the complexity , side effects and costs associated with each regimen . This trial was registered at Clinical Trials . Gov ( NCT 02349685 ) . Results : In the 219 patients included , the intention to treat ( ITT ) and per protocol ( PP ) eradication rates was 75.3 % and 79.8 % in the 14-day EBMT group ( n=89 ) , 70.8 % and 72.4 % in the 14-day MEA group ( n=89 ) and 87.8 % and 100.0 % in the 14-day tailored therapy group ( n=41 ) , respectively . Based on the PP analysis , the 14-day tailored therapy group showed a significantly higher eradication rate than the 14-day EBMT or MEA group ( both p ≤ 0.001 ) . Conclusions : Tailored therapy based on H. pylori culture and MIC test could be an option as a second-line eradication regimen in the presence of high level of antimicrobial resistance Background : Helicobacter pylori ( H pylori ) is a common gastric pathogen which is associated with chronic gastritis , peptic ulcer , and gastric cancer . It has worldwide distribution with higher incidence in developing countries . Gemifloxacin is a fluoroquinolone antibiotic with documented in vitro activity against H pylori . Considering that there is no clinical data to verify gemifloxacin efficacy in H pylori eradication , this pilot clinical trial was design ed . Methods : This prospect i ve pilot study was performed during February 2014 to February 2015 . A regimen of gemifloxacin ( 320 mg single dose ) plus twice daily doses of amoxicillin1 g , bismuth 240 mg , and omeprazole 20 mg for 14 days were prescribed for H pylori infected patients in whom a first-line st and ard quadruple therapy ( clarithromycin – amoxicillin – bismuth – omeprazole ) had failed . To confirm H pylori eradication a 13C-urea breath test was performed 4 weeks after treatment . Compliance and incidence of adverse effects were evaluated by question naires . Results : A total of 120 patients were enrolled consecutively ; out of which 106 patients achieved H pylori eradication ; per- protocol and intention-to-treat eradication rates were 91.4 % ( 95 % CI : 85.5–97.6 ) and 88.3 % ( 95 % CI : 75.4–92.4 ) respectively . Three patients ( 2.5 % ) failed to take at least 80 % of the drugs and excluded from the final analysis . Adverse effects were reported in 42 % of patients , most commonly including nausea ( 15 % ) and diarrhea ( 13.3 % ) , which was intense in 1 patient and led to the discontinuation of treatment . In total , 96.7 % ( 116/120 ) of the patients took the medications correctly . Conclusion : This study revealed that gemifloxacin-containing quadruple therapy  provides high H pylori eradication rate ( ≥90 % PP cure rate ) , and this agent can be included in the list of second-line H pylori therapeutic regimens Background sThe present study sought to establish a st and ard third-line eradication regimen for Helicobacter pylori in Japan . Methods Subjects were 204 patients with H. pylori infection in whom the st and ard Japanese first- and second-line eradication therapies had proven unsuccessful . Patients were r and omly assigned to one of the following third-line eradication therapy groups : ( 1 ) LA group : lansoprazole ( LPZ ) 30 mg 4 times a day ( qid ) + amoxicillin ( AMPC ) 500 mg qid for two weeks ; ( 2 ) LAL group : LPZ 30 mg twice a day ( bid ) + AMPC 750 mg bid + levofloxacin ( LVFX ) 300 mg bid for one week ; ( 3 ) LAS group : LPZ 30 mg bid + AMPC 750 mg bid + sitafloxacin ( STFX ) 100 mg bid for one week . Patients for whom these therapies failed underwent a crossover fourth-line eradication regimen . Drug sensitivity was also tested for AMPC , clarithromycin ( CAM ) , MNZ , LVFX , and STFX . Results Drug resistance rates prior to third-line eradication therapy were 86.4 % for CAM , 71.3 % for MNZ , 57.0 % for LVFX , 8.2 % for AMPC , and 7.7 % for STFX . Intention-to-treat analysis of third-line eradication therapy eradication rates showed a significantly higher rate in the LAS group ( 70.0 % ) compared with the LA group ( 54.3 % ; p < 0.05 ) and the LAL group ( 43.1 % ; p < 0.001 ) . The significantly lower rate in the LAL group than the LAS group was caused by bacterial resistance to LVFX . Conclusions The findings suggest that triple therapy with PPI , AMPC , and STFX for one week would be an effective st and ard third-line eradication regimen for H. pylori in Japan ZusammenfassungEINLEITUNG : In der klinischen Praxis stellt die Eradikation von  Helikobacter pylori ( HP ) noch immer eine problematische Therapie dar . Ziel ist , eine hohe Eradikationsrate zu einem niedrigen Preis zu erzielen ; die derzeitigen Beh and lungsmöglichkeiten geben uns dazu die Möglichkeit . Kürzlich veröffentlichte Result ate mit einer auf Moxifloxacin basierten Therapie zeigten eine niedrige Resistenzrate und eine gute Kompliance . Die vorliegende Studie untersucht die Wirksamkeit des Einsatzes von Moxifloxacin i m Rahmen einer Triple-Therapie zur Eradikation von HP . ZIEL UND METHOD EN : Ziel unserer Studie war es , die Wirksamkeit einer einwöchigen Moxifloxacin-basierten HP-Eradikationstherapie mit der St and 
    Output:
    
Therapies containing fourth-generation quinolones achieved a poor eradication rate in the treatment of H. pylori infection .