{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T23:33:13Z","timestamp":1784158393205,"version":"3.55.0"},"reference-count":44,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,3,14]],"date-time":"2018-03-14T00:00:00Z","timestamp":1520985600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The increasing prevalence of strains resistant to antimicrobial agents is a critical issue in the management of <jats:italic>Helicobacter pylori (H. pylori)<\/jats:italic> infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>(1) To evaluate the prevalence of primary resistance to clarithromycin, metronidazole and levofloxacin (2) to assess the effectiveness of sequential therapy on resistant strains (3) to identify the minimum number of subjects to enrol for evaluating the effectiveness of an eradication regimen in patients harbouring resistant strains.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consecutive 1682 treatment na\u00efve <jats:italic>H.\u00a0pylori\u2010<\/jats:italic>positive patients referred for upper <jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content> endoscopy between 2010 and 2015 were studied and resistances assessed by E\u2010test. Sequential therapy was offered, effectiveness evaluated and analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:italic>H. pylori<\/jats:italic>\u2010primary resistance to antimicrobials tested was high, and increased between 2010 and 2015. Eradication rates were (estimates and 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>s): 97.3% (95.6\u201098.4) in strains susceptible to clarithromycin and metronidazole; 96.1% (91.7\u201098.2) in strains resistant to metronidazole but susceptible to clarithromycin; 93.4% (88.2\u201096.4) in strains resistant to clarithromycin but susceptible to metronidazole; 83.1% (77.7\u201087.3) in strains resistant to clarithromycin and metronidazole. For any treatment with a 75%\u201085% eradication rate, some 98\u2010144 patients with resistant strains need to be studied to get reliable information on effectiveness in these patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:italic>H. pylori<\/jats:italic>\u2010primary resistance is increasing and represents the most critical factor affecting effectiveness. Sequential therapy eradicated 83% of strains resistant to clarithromycin and metronidazole. Reliable estimates of the effectiveness of a given regimen in patients harbouring resistant strains can be obtained only by assessing a large number of strains.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.14597","type":"journal-article","created":{"date-parts":[[2018,3,15]],"date-time":"2018-03-15T11:46:01Z","timestamp":1521114361000},"page":"1261-1269","source":"Crossref","is-referenced-by-count":47,"title":["Impact of primary antibiotic resistance on the effectiveness of sequential therapy for <i>Helicobacter pylori<\/i> infection: lessons from a 5\u2010year study on a large number of strains"],"prefix":"10.1111","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5789-3813","authenticated-orcid":false,"given":"L.","family":"Gatta","sequence":"first","affiliation":[{"name":"Gastroenterogy Unit Versilia Hospital Azienda USL Toscana Nord Ovest Lido di Camaiore Italy"},{"name":"Clinical Pharmacology and Digestive Pathophysiology Unit Department of Clinical and Experimental Medicine University of Parma Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5645-857X","authenticated-orcid":false,"given":"C.","family":"Scarpignato","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Digestive Pathophysiology Unit Department of Clinical and Experimental Medicine University of Parma Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Fiorini","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences S. 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