{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:02:00Z","timestamp":1788498120049,"version":"build-2803163510"},"reference-count":42,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T00:00:00Z","timestamp":1754611200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T00:00:00Z","timestamp":1754611200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Helicobacter pylori<\/jats:italic>\n                      (HP) clinical guidelines encourage obtaining gastric biopsy culture and antimicrobial susceptibilities to guide therapy. Susceptibility\u2010guided treatment (SGT) reduces unnecessary exposure to ineffective antibiotics, minimizes adverse events, and promotes antimicrobial stewardship. However, real\u2010world data on its effectiveness remains limited. We aim to compare the efficacy of SGT to empirical therapy (ET).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Retrospective cohort study, single pediatric tertiary care center, Boston Children's Hospital, January\/2019 to June\/2024. First\u2010time\n                      <jats:italic>H. pylori\u2010<\/jats:italic>\n                      histological diagnosis and subsequent treatment. Data extracted: demographic variables, endoscopy indications, endoscopic and histological findings, prior antimicrobial use, treatment regimen, eradication, and antimicrobial susceptibility. We compared eradication rates on patients who received ET versus those who received SGT and among SGT recipients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Two hundred and eighteen study subjects (95 ET, 123 SGT) were included. Mean age:13.6\u2009\u00b1\u20094.8 years, 50.9% male, 59.6% White, 38.1% Hispanic. Endoscopic findings: gastritis (92.7%), duodenitis (11.5%), gastric ulcer\/erosion (5.0%), duodenal ulcer\/erosion (13.3%). Eradication success was significantly higher in the SGT group (89.4%,110\/121) compared to the ET group (70.2%, 66\/94) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Resistance rates: clarithromycin (26.8%), metronidazole (18.7%), fluoroquinolones (9.8%), amoxicillin (3.3%), rifampin (8.9%), no tetracycline resistance. Amoxicillin resistance was strongly associated with failure (27.3% vs. 0.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), as was dual clarithromycin\u2010metronidazole resistance (36.4% vs. 8.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018). In univariate analysis, amoxicillin resistance had the strongest association with failure (odds ratio [OR] 40.9,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), followed by dual clarithromycin\u2010metronidazole resistance (OR 6.41,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016), and metronidazole resistance (OR 4.26,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.034).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SGT resulted in higher eradication rates than ET. Clarithromycin and metronidazole resistance rates were &gt;15%. Antibiotic resistance, especially to amoxicillin, is a major driver of eradication failure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jpn3.70191","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T09:28:08Z","timestamp":1754645288000},"page":"1133-1141","source":"Crossref","is-referenced-by-count":3,"title":["Antimicrobial susceptibility\u2010guided treatment is superior to empiric therapy for\n                    <i>Helicobacter pylori<\/i>\n                    infection in children"],"prefix":"10.1002","volume":"81","author":[{"given":"Christina","family":"Chan","sequence":"first","affiliation":[{"name":"Institutional Centers for Clinical and Translational Research Boston Children's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athos","family":"Bousvaros","sequence":"additional","affiliation":[{"name":"Harvard Medical School and Boston Children's Hospital Division of Pediatric Gastroenterology, Hepatology, and Nutrition Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey D.","family":"Goldsmith","sequence":"additional","affiliation":[{"name":"Harvard Medical and Boston Children's Hospital Department of Pathology Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enju","family":"Liu","sequence":"additional","affiliation":[{"name":"Institutional Centers for Clinical and Translational Research Boston Children's Hospital Boston Massachusetts USA"},{"name":"Harvard Medical School and Boston Children's Hospital Division of Pediatric Gastroenterology, Hepatology, and Nutrition Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6665-825X","authenticated-orcid":false,"given":"Silvana","family":"Bonilla","sequence":"additional","affiliation":[{"name":"Harvard Medical School and Boston Children's Hospital Division of Pediatric Gastroenterology, Hepatology, and Nutrition Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.04.022"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.32074\/1591-951X-163"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30488-7"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/jpn3.12314"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.04.006"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000002968"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2018.03.013"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2022-327745"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2021-324032"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.07.007"},{"key":"e_1_2_7_12_1","unstructured":"World Health Organization.Global Priority List of Antibiotic\u2010Resistant Bacteria to Guide Research Discovery and Development of New Antibiotics. 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