***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: In patients with a first eradication failure , a second ( rescue ) therapy still fails in > 20 % of cases ABSTRACT Culture and susceptibility testing of Helicobacter pylori strains was performed in a large multinational , multicenter r and omized clinical trial . Culture was carried out on gastric biopsy sample s obtained from 516 patients at entry and had a sensitivity of 99 % when the [13C]urea breath test was used as a reference . Susceptibility testing was performed for clarithromycin and metronidazole on 485 strains by an agar dilution method and the epsilometer test ( Etest ) and for amoxicillin by an agar dilution method only . Resistance to clarithromycin  ( > 1 μg/ml ) was found in 3 % of the H. pylori strains , with a perfect correlation between Etest and agar dilution methods . Resistance to metronidazole  ( > 8 μl/ml ) was found in 27 % of the strains by agar dilution , but there were important discrepancies between it and the Etest method . No resistance to amoxicillin was found . The logarithms of the MICs of the three antibiotics against susceptible strains had a distribution close to normal . The impact of resistance was tested in the four arms of the trial . There were not enough clarithromycin-resistant strains to evaluate the impact of resistance on the cure rate of clarithromycin-based regimens . For metronidazole-resistant strains , the impact noted in the clarithromycin-metronidazole arm was partially overcome when omeprazole was added ( 76 % eradication for resistant strains versus 95 % for susceptible strains ) . Secondary resistance to clarithromycin occurred in strains from 12 of 105 patients ( 11.4 % ) after the failure of a clarithromycin-based regimen to effect eradication . The detection of point mutations in clarithromycin-resistant strains was performed by a combination of PCR and restriction fragment length polymorphism . Mutations ( A2142 G and 2143 G ) were found in all strains tested except one . This study stresses the importance of performing susceptibility tests in clinical trials in order to explain the results of different treatments Background : An  antimicrobial susceptibility test  for Helicobacter pylori before second‐line treatment is often performed , although whether the test is truly necessary remains unknown The third-line treatment regimen for Helicobacter pylori after failure of clarithromycin- and metronidazole-based therapies is not yet established . Sitafloxacin ( STX ) is a quinolone that possesses potent in vitro activity against H. pylori . In this study , the susceptibility of H. pylori isolates to STX was examined and the efficacy of STX-based triple therapy as a third-line regimen was evaluated . STX showed minimum inhibitory concentrations ( MICs ) of ≤1 μg/mL against all 100 H. pylori isolates , and the MIC(90 ) ( MIC for 90 % of the organisms ) of STX was 5 log(2 ) dilutions lower than that of levofloxacin ( LVX ) . The MIC(50 ) ( MIC for 50 % of the organisms ) of STX against gyrA mutants was 0.12 μg/mL and was significantly lower than that of LVX ( 8 μg/mL ) . The activity of  STX  at pH 5.5 was significantly less than that at pH 7.0 . In the clinical trial , 28 patients with two eradication failures were treated with STX-based triple therapy [ rabeprazole 10 mg twice daily ( b.i.d . ) , amoxicillin 750 mg b.i.d . and STX 100 mg b.i.d . for 7 days ] . The eradication rate was 75 % using intention-to-treat analysis and 80 % using per- protocol analysis . Two gyrA mutant strains were eradicated . Amongst participants , a low pepsinogen I/II ratio was associated with successful eradication . These results suggest that STX could be active against most clinical H. pylori isolates and that STX-based triple therapy is a promising and safe third-line therapy Helicobacter pylori eradication rates by triple therapy with a proton pump inhibitor , amoxicillin , and clarithromycin at st and ard doses depend on bacterial susceptibility to clarithromycin and patient CYP2C19 genotypes . We examined the usefulness of a personalized therapy for H. pylori infection based on these factors as determined by genetic testing . First , optimal lansoprazole dosing schedules that would achieve sufficient acid inhibition to allow H. pylori eradication therapy in each of different CYP2C19 genotype groups were determined by a 24‐h intragastric pH monitoring . Next , 300 H. pylori‐positive patients were r and omly assigned to the st and ard regimen group ( lansoprazole 30 mg twice daily ( b.i.d . ) ) , clarithromycin 400 mg b.i.d . , and amoxicillin 750 mg b.i.d . for 1 week ) or the tailored regimen group based on CYP2C19 status and bacterial susceptibility to clarithromycin assessed by genetic testing . Patients with failure of eradication underwent the second‐line regimen . The per‐patient cost required for successful eradication was calculated for each of the groups . In the first‐line therapy , the intention‐to‐treat eradication rate in the tailored regimen group was 96.0 % ( 95 % CI=91.5–98.2 % , 144/150 ) , significantly higher than that in the st and ard regimen group ( 70.0 % : 95 % CI=62.2–77.2 % , 105/150 ) ( P<0.001 ) . Final costs per successful eradication in the tailored and st and ard regimen groups were $ 669 and $ 657 , respectively . In conclusion , the pharmacogenomics‐based tailored treatment for H. pylori infection allowed a higher eradication rate by the initial treatment without an increase of the final per‐patient cost for successful eradication . However , the precise cost‐effectiveness of this strategy remains to be determined BACKGROUND Clarithromycin-resistant Helicobacter pylori is associated with point mutations in the 23S ribosomal RNA ( rRNA ) gene . METHODS A total of 1232 patients participated and were divided into 2 control groups and 1 case group . Patients in the APC control group , which consisted of 308 r and omly assigned participants , were treated with st and ard triple therapy , consisting of amoxicillin , rabeprazole , and clarithromycin ;  308 participants in the APM control group were treated with amoxicillin , rabeprazole , and metronidazole . For the 616 participants in the case group , a test for point mutations in the 23S rRNA gene of H. pylori was conducted . A total of 218 individuals in the case group received a new tailored therapy regimen , in which amoxicillin , rabeprazole , and clarithromycin were given in the absence of a mutation , whereas clarithromycin was replaced by metronidazole if the mutation was detected . RESULTS The rate of eradication of H. pylori in the tailored group was 91.2 % ( 176/193 ) , which was significantly higher than that in the APC ( 75.9 % [ 214/282 ] ; P < .001 ) and APM ( 79.1 % [ 219/277 ] ; P < .001 ) control groups . CONCLUSION The rate of H. pylori eradication among patients who received tailored therapy on the basis of detection of a clarithromycin resistance mutation by polymerase chain reaction was much higher than the rate among patients who received a st and ard triple therapy regimen . CLINICAL TRIALS REGISTRATION NCT0145303 OBJECTIVES : Helicobacter pylori eradication rates with clarithromycin-based triple therapy are declining , and an alternative strategy is needed urgently . We sought to compare the efficacy of pretreatment antimicrobial susceptibility-guided vs. clarithromycin-based triple therapy for H. pylori eradication in a region with high rates of multiple drug resistance . METHODS : Consecutive H. pylori-infected patients with gastric epithelial neoplasms were r and omized to receive antimicrobial susceptibility-guided therapy or clarithromycin-based triple therapy for 7 days . In patients in whom the infection was not eradicated , antibiotics were given according to an initial antimicrobial susceptibility test as a second-line therapy in both groups . Eradication rates , antibiotics resistance rates , and drug compliance owing to adverse effects were compared between the groups . RESULTS : In total , 114 patients were enrolled , and 112 completed the protocol s. Drug compliance and side effects were similar between the groups . The intention-to-treat eradication rates were 94.7 % ( 95 % confidence interval (CI)=88.8–100 % , 54/57 ) in the antimicrobial susceptibility-guided group and 71.9 % ( 95 % CI=60.2–83.5 % , 41/57 ) in the clarithromycin-based triple therapy group after the initial treatment ( P=0.002 ) , whereas the per- protocol ( PP ) eradication rates were 96.4 % ( 95 % CI=91.5–100 % , 54/56 ) in the antimicrobial susceptibility-guided group and 73.2 % ( 95 % CI=61.5–84.8 % , 41/56 ) in the clarithromycin-based triple therapy group ( P=0.001 ) . In H. pylori with clarithromycin resistance , the eradication failure rate with first-line treatment was lower in the susceptibility-guided therapy group ( 0 % , 0/12 ) compared with the clarithromycin-based triple therapy group ( 80.0 % , 95 % CI=59.7–100 % , 12/15 ) by PP analysis ( P<0.001 ) . CONCLUSIONS : Pretreatment antimicrobial susceptibility-guided therapy is more effective than clarithromycin-based triple therapy for H. pylori eradication in a region with high rates of multiple drug resistance BACKGROUND / AIMS Proton-pump inhibitor (PPI)-based triple therapy for Helicobacter pylori eradication is widely used with considerable failure rate . Bismuth-based , second-line therapy is also associated with failures in more than 20 % of cases in Korea . Our aim was to evaluate the efficacy and tolerability of third-line therapy containing moxifloxacin as a rescue in Korea . METHODS The subjects consisted of 201 patients infected with H. pylori , who were treated with PPI-based therapy , 42 patients treated with bismuth-based after failure of initial PPI triple therapy , and 10 patients treated with moxifloxacin-containing triple therapy after failure of successive initial and second-line therapy .  Eradication rate , compliance and side effect rates were compared . RESULTS The eradication rates of initial , second-line , and third-line therapy were as follows : 67.2%/83.3 % , 54.8%/76.7 % , 80.0%/88.9 % by intention-to-treat and per protocol analysis , respectively . The compliance of patients for each treatment was 98.2 % , 90.9 % , 100 % , respectively . The side effect rate was significantly higher in the bismuth triple therapy than in the PPI- or moxifloxacin-containing triple therapy ( p<0.05 ) . CONCLUSIONS Moxifloxacin-containing triple therapy shows high eradication rate with fewer side effects and good compliance . Thus , this regimen could be used as a rescue therapy AIMS To compare two strategies for the eradication of Helicobacter pyloriinfection . METHODS Groups 1 and 2 each consisted of 75 consecutive patients . Patients in group 1 were treated with two antibiotics based on antibiotic susceptibility testing ; those in group 2 received amoxycillin and clarithromycin for eight days , together with either ranitidine or omeprazole .  Eradication rate was assessed in both groups six months after treatment . RESULTS In group 1,H pylori grew in culture in 63/75 cases . Susceptibility testing showed that 35/63 isolates were resistant to metronidazole , 10/63 to clarithromycin , 2/63 to ampicillin , 1/63 to tetracycline , and 5/63 to both clarithromycin and metronidazole . In group 1 the infection was eradicated in 96 % of the initial 75 subjects , and in 98 % of the subjects treated according to the antibiotic assay ( 62/63 ) . As two patients were lost at follow up the overall eradication rate was 99 % . In group 2 , eradication was achieved in 61/75 subjects ( 
    Output:
    
Once endoscopy and culture have been performed , SGT is superior to empirical 7 or 10 day triple therapy for first-line treatment .