***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 UNLABELLED Moxifloxacin has been used in the first-line treatment of Helicobacter pylori infection . The optimal dosage and duration have not been assessed . AIM To evaluate the effectiveness of moxifloxacin , amoxicillin and esomeprazole in four regimens , in previously untreated patients infected by H. pylori . METHODS AND PATIENTS Patients were r and omly assigned to : esomeprazole 20 mg b.i.d . , amoxicillin 1 g b.i.d . , and one of each of the four following dosages of moxifloxacin : moxifloxacin 400 mg b.i.d . for 10 days ( EAM800x10 ) , moxifloxacin 400 mg b.i.d . for 7 days ( EAM800x7 ) , moxifloxacin 400 mg b.i.d . for 5 days ( EAM800x5 ) , moxifloxacin 400 mg o.i.d . for 10 days ( EAM400x10 ) . Eradication was assessed by the Urea Breath Test ( UBT ) 2 months following the end of therapy . RESULTS Ninety-four , 102 , 92 and 105 patients were recruited in EAM800x10 , EAM800x7 , EAM800x5 , and EAM400x10 respectively . The eradication rate was for Intention-To-Treat ( ITT ) and Per Protocol ( PP ) analyses : EAM800x10 group ITT : 90.4 % , PP : 94.4 % ; EAM800x7 group ITT : 80.3 % , PP : 86.3 % ; EAM800x5 group ITT : 71.4 % , PP : 75.2 % ; EAM400x10 group ITT : 80.0 % , PP 84.8 % . A statistically significant difference was reached between EAM800x10 vs. EAM800x7 ( ITT and PP : P<0.05 ) , and between EAM800x10 vs. EAM800x5 ( ITT and PP : P<0.01 ) and vs. EAM400x10 ( ITT : P<0.05 ; PP : P<0.04 ) . Thirty patients treated unsuccessfully with EAM800x5 and EAM400x10 were re-treated with EAM800x10 with an eradication rate of 86.7 % ( ITT ) and 92.2 % ( PP ) . Nineteen patients with positive UBT after EAM800x10 and EAM800x7 underwent a second-line rifabutin-based therapy with an eradication rate of 84.2 % ( ITT and PP ) . CONCLUSION A triple therapy with 800 mg of moxifloxacin a day for 10 days is more effective than the same treatment for 5 or 7 days and a treatment with 400 mg of moxifloxacin a day for 1 
    Output:
    
The eradication rates of the st and ard triple therapy are unacceptable ( ≤80 % ) in countries where H.pylori is highly resistant to clarithromycin and metronidazole .
Administration of the st and ard triple therapy for more than 7 days does not improve its effectiveness .
No statistically significant differences were observed between the eradication rates of the quadruple therapy with bismuth  and  the st and ard triple therapy .
Even though the sequential and concomitant therapies are equally successful regimens , the triple therapy with levofloxacin offers the best results as first and second-line treatment , but quinolone resistance can diminish its effectiveness .
The triple therapy with levofloxacin and the sequential and concomitant treatments were superior to the st and ard triple regimen as first-line therapy .
Currently there is no ideal first or second-line treatment for achieving 100 % eradication .