***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: 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 BACKGROUND & AIMS Sequential therapy with a proton pump inhibitor ( PPI ) and amoxicillin followed by a PPI , clarithromycin , and an imidazole agent reportedly have a better rate of curing Helicobacter pylori infection than PPI , amoxicillin , and clarithromycin triple therapy . The concomitant administration of these 4 drugs ( concomitant therapy ) is also an effective treatment strategy . We compared the efficacies of sequential and concomitant therapy and analyzed the effects of antibiotic resistance in patients with H pylori infection . METHODS In a r and omized trial of 232 H pylori-infected patients from 3 hospitals in Kaohsiung , Taiwan , patients were given 10 days of sequential ( n = 115 ) or concomitant ( n = 117 ) therapy . H pylori status was confirmed by endoscopy or urea breath test . RESULTS Intention-to-treat analysis demonstrated similar eradication rates for sequential ( 92.3 % ; 95 % confidence interval [ CI ] , 87.5%-97.1 % ) and concomitant therapy ( 93.0 % ; 95 % CI , 88.3%-97.7%)(P = .83 ) . Per- protocol eradication results were similar for sequential ( 93.1 % ; 95 % CI , 90.7%-95.5 % ) and concomitant therapy ( 93.0 % ; 95 % CI , 88.3%-97.7 % ) ( P = .99 ) . Univariate analysis showed that compliance and resistance to clarithromycin  were independent determinants of eradication . Dual resistance did not influence the level of eradication in the concomitant group , but significantly affected that of the sequential therapy group .  Clarithromycin resistance was less frequent than expected . CONCLUSIONS Sequential or concomitant therapy with a PPI , amoxicillin , clarithromycin , and an imidazole agent are equally effective and safe for eradication of H pylori infection . Resistance to clarithromycin , compliance , and adverse events reduced the level of eradication . Concomitant therapy may be more suitable for patients with dual resistance to antibiotics BACKGROUND The eradication rate with PPI-based st and ard triple therapy for Helicobacter pylori infection has fallen considerably . One recent innovation is sequential therapy with PPI and three antibiotics , but the complexity of this regimen may reduce its usability . Concomitant administration of nonbismuth quadruple drugs ( concomitant therapy ) is also an effective treatment strategy . To investigate which regimen is a reasonable choice for Korean population , we performed two pilot studies with sequential and concomitant therapies . METHODS A total of 164 patients with proven H. pylori infection r and omly received 14 days of sequential ( n = 86 ) or concomitant ( n = 78 ) therapies . The sequential group received 20 mg rabeprazole and 1 g amoxicillin ( first week ) , followed by 20 mg rabeprazole , 500 mg clarithromycin , and 500 mg metronidazole ( second week ) . The concomitant group received 20 mg rabeprazole , 1 g amoxicillin , 500 mg clarithromycin , and 500 mg metronidazole for 2 weeks . All drugs were administered BID . Helicobacter pylori status was confirmed 4 weeks later , after completion of treatment by ( 13 ) C-urea breath test . RESULTS The intention-to-treat and per- protocol eradication rates were 75.6 % ( 95 % CI , 66.3 - 84.9 ) and 76.8 % ( 95 % CI , 67.1 - 85.5 ) in the sequential group , and 80.8 % ( 95 % CI , 71.8 - 88.5 ) and 81.3 % ( 95 % CI , 71.6 - 90.7 ) in the concomitant group . There were no significant between-group differences , in regard to the eradication rates , compliance , or side effects . The most common side effects were bitter taste , epigastric soreness , and diarrhea . CONCLUSIONS Two-week concomitant and sequential therapies showed suboptimal efficacies . However , considering high antibiotics resistance , either of these two regimens may be a reasonable choice for Korean population Objectives : Comparison of Helicobacter pylori eradication rates , side effects , compliance , cost , and ulcer recurrence of sequential therapy ( ST ) with that of concomitant therapy ( CT ) in patients with perforated duodenal ulcer following simple omental patch closure . Methods : Sixty-eight patients with perforated duodenal ulcer treated with simple closure and found to be H. pylori positive on three months follow-up were r and omized to receive either ST or CT for H. pylori eradication .  Urease test and Giemsa stain were used to assess for H. pylori eradication status . Follow-up endoscopies were done after 3 months , 6 months , and 1 year to evaluate the ulcer recurrence . Results : H. pylori eradication rates were similar in ST and CT groups on intention-to-treat ( ITT ) analysis ( 71.43 % vs 81.80%,P = 0.40 ) . Similar eradication rates were also found in per- protocol ( PP ) analysis ( 86.20 % vs 90%,P = 0.71 ) . Ulcer recurrence rate in ST groups and CT groups at 3 months ( 17.14 % vs 6.06%,P = 0.26 ) , 6 months ( 22.86 % vs 9.09%,P = 0.19 ) , and at 1 year ( 25.71 % vs 15.15%,P = 0.37 ) of follow-up was also similar by ITT analysis . Compliance and side effects to therapies were comparable between the groups . The most common side effects were diarrhoea and metallic taste in ST and CT groups , respectively . A complete course of ST costs Indian Rupees ( INR ) 570.00 , whereas CT costs INR 1080.00 . Conclusion : H. pylori eradication rates , side effects , compliance , cost , and ulcer recurrences were similar between the two groups . The ST was more economical compared with CT Treatments with bismuth-containing quadruple therapy ( QT ) , sequential therapy ( ST ) , or concomitant therapy ( CT ) have been proposed as empirical first-line regimens for Helicobacter pylori . We compared the efficacy and tolerability of 10 days bismuth-containing quadruple QT , 10 days ST , and 10 days CT with as first-line treatments for H. pylori in a r and omized crossover study . The subjects were r and omly divided into three groups . The first 130 patients were treated with rabeprazole , bismuth potassium citrate , metronidazole , and tetracycline for 10 days . The second 130 patients in the sequential group were treated with rabeprazole and amoxicillin for 5 days , and then rabeprazole , clarithromycin , and metronidazole for an additional 5 days . The last 130 patients in the concomitant group were treated with rabeprazole , amoxicillin , clarithromycin , and metronidazole for 10 days . H. pylori eradication was confirmed by urea breath test at 6 weeks . The primary outcome was eradication rates of first-line treatment by intention to treat and per protocol ( PP ) analyzes . There was no difference between the average ages and the male/female ratio of the groups . The PP analysis was performed on 121 , 119 , and 118 patients in the QT , ST , and CT groups , respectively . In the PP analysis , the successful eradication 94.2 % ( 114/121 ) , 95.0 % ( 113/119 ) , and 95.8 % ( 113/118 ) the QT , ST , and CT groups , respectively . There was no significant difference among the three groups ( p = 0.86 ) . 10 days QT , ST , and CT are highly effective as empirical first-line therapies for H. pylori in the region with high clarithromycin resistance Abstract : To eluci date whether pretreatment with omeprazole decreases the cure rate of Helicobacter pylori infection  with a new quadruple therapy , and thus , whether this pretreatment should not be used in clinical practice , we conducted a r and omized trial . Ninety patients with chronic peptic ulcer disease and nonulcer dyspepsia , with biopsy-proven H. pylori infection were r and omly assigned to the two following regimens : Group 1 ( n = 45 ) received omeprazole 20 mg once daily for 2 weeks ( days 1–14 ) , and 500 mg amoxicillin granules and 250 mg metronidazole thrice daily , and roxithromycin 150 mg twice daily for 1 week ( days 8–14 ) , Group 2 ( n = 45 ) received the same antibiotic treatment as group 1 for 1 week ( days 1–7 ) , in addition to omeprazole treatment for 2 weeks ( days 1–14 ) . Four weeks after the treatment ended , endoscopy was repeated , with two biopsy specimens each taken from the antrum and the corpus ( total of four specimens ) for a urease test , histological analysis , and culture to establish cure of infection . A patient was regarded as cured only if all three methods gave negative results for H. pylori . In the intention-to-treat analysis , 42 of 45 patients ( 93.3 % ; 95 % confidence intervals [ CI ] , 81.7%–98.6 % ) in group 1 were cured compared with 43 of 45 patients ( 95.6 % ; 95 % CI , 84.9%–99.5 % ) in group 2 . In the per- protocol analysis , the corresponding figures were 42/44 ( 95.5 % ; 95 % CI 84.5%–99.4 % ) and 43/44 ( 97.7 % ; 95 % CI , 88.0%–99.9 % ) . There were no significant differences in the cure rate between the two groups on either analysis . All patients , except for one who had an allergic reaction , completed the treatment regimens . Fifty to sixty percent of the patients had no side effects while the rest had mild to moderate side effects . The new quadruple therapy consisting of omeprazole , amoxicillin , metronidazole , and roxithromycin appears suitable for use in clinical practice , as the cure rate was 95 % and no severe side effects were observed . Pretreatment with omeprazole did not reduce the cure rate for this new quadruple therapy BACKGROUND Whether sequential treatment can replace triple therapy as the st and ard treatment for Helicobacter pylori infection is unknown . We compared the efficacy of sequential treatment for 10 days and 14 days with triple therapy for 14 days in first-line treatment . METHODS For this multicentre , open-label , r and omised trial , we recruited patients ( ≥20 years of age ) with H pylori infection from six centres in Taiwan . Using a computer-generated r and omisation sequence , we r and omly allocated patients ( 1:1 
    Output:
    
The eradication rate of 10-day sequential therapy was superior to that of 5-day concomitant therapy ( 82.09 versus 77.79 % , relative risk ( RR ) 1.052 ( 95 % confidence interval ( CI ) 1.004–1.103 ) , P = 0.035 ) ) , similar to that of 7-day concomitant therapy ( 82.40 versus 86.99 % , RR 0.959 ( 95 % CI 0.874–1.053 ) , P = 0.382 ) , and inferior to that of 10-day concomitant therapy ( 78.39 versus 83.32 % , RR 0.945 ( 95 % CI 0.907–0.984 , P = 0.006 ) ; the occurrence of diarrhea was higher in 10-day concomitant therapy than that in 10-day sequential therapy .
Conclusion The efficacy of concomitant therapy was duration dependent , and 10-day concomitant therapy was superior to 10-day sequential therapy .
Compared to sequential therapy , concomitant therapy was more efficacious for metronidazole-resistant strains and metronidazole plus clarithromycin-resistant strains .
However , diarrhea was more frequent with concomitant therapy than with sequential therapy