{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:09:01Z","timestamp":1790611741930,"version":"4.1.0"},"reference-count":49,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,4,24]],"date-time":"2019-04-24T00:00:00Z","timestamp":1556064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"The grant from Clinical Research Center, Shanghai Jiao Tong University School of Medicine","award":["DLY201608"],"award-info":[{"award-number":["DLY201608"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Increasing\n                      <jats:italic>Helicobacter pylori<\/jats:italic>\n                      resistance has led to decreases in treatment effectiveness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>\n                      To test the effectiveness of susceptibility\u2010guided therapy vs a locally highly effective empiric modified bismuth quadruple therapy for first\u2010line\n                      <jats:italic>H\u00a0pylori<\/jats:italic>\n                      treatment in a region with high antimicrobial resistance\n                      <jats:bold>.<\/jats:bold>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We compared 14\u2010day susceptibility\u2010guided with empiric therapy using a multicentre superiority\u2010design trial, which randomised\n                      <jats:italic>H\u00a0pylori<\/jats:italic>\n                      infected subjects 3:1 to (a) susceptibility\u2010guided therapies contained esomeprazole 20\u00a0mg and amoxicillin 1\u00a0g b.d. plus clarithromycin 500\u00a0mg, metronidazole 400\u00a0mg b.d., or levofloxacin 500\u00a0mg daily for susceptible infections or bismuth 220\u00a0mg b.d. and metronidazole 400\u00a0mg q.d.s. for triple\u2010resistant infections; (b) Empiric therapy contained esomeprazole 20\u00a0mg, bismuth 220\u00a0mg b.d., amoxicillin 1\u00a0g and metronidazole 400\u00a0mg t.d.s. Primary outcome was\n                      <jats:italic>H\u00a0pylori<\/jats:italic>\n                      eradication.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between February 2017 and March 2018, 491 subjects were screened and 382 were randomised. Both the susceptibility\u2010guided and the empiric regimens were highly successful with per\u2010protocol eradication rates of 97.7% (250\/256) vs 97.6% (81\/83,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a01.00) and intent\u2010to\u2010treat eradication rates of 91.6% (262\/286) vs 85.4% (82\/96,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.12). Overall, susceptibility\u2010guided therapy was not superior to empiric therapy with 0.1% per\u2010protocol (95% CI \u22123.1% to 3.2%) and 6.2% intent\u2010to\u2010treat (\u22120.3% to 12.7%) eradication difference. Both approaches had high adherence and low adverse event rates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both susceptibility\u2010guided and empiric therapies provided excellent eradication rates. Clinically, the choice would hinge on availability of susceptibility testing and\/or a locally highly effective empiric therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.15273","type":"journal-article","created":{"date-parts":[[2019,4,24]],"date-time":"2019-04-24T21:22:07Z","timestamp":1556140927000},"page":"1385-1394","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":88,"title":["Randomised controlled trial: susceptibility\u2010guided therapy versus empiric bismuth quadruple therapy for first\u2010line\n                    <i>Helicobacter pylori<\/i>\n                    treatment"],"prefix":"10.1111","volume":"49","author":[{"given":"Qi","family":"Chen","sequence":"first","affiliation":[{"name":"Shanghai 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