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The aim of this study was to indirectly assess the applicability and effectiveness of susceptibility\u2010guided treatment by evaluating (a) the rate of acceptance of endoscopy, (b) its success in detecting resistances, and (c) infection cure rates in patients harboring strains found to be susceptible to the antibiotics administered in clinical trials in which the efficacy of second\u2010line treatments was reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review of studies evaluating second\u2010line <jats:italic>H\u00a0pylori<\/jats:italic> treatment was carried out in multiple databases. Studies reporting antibiotic susceptibility evaluation and\/or cure rates in patients harboring sensitive and resistant strains were selected. Data were extracted in duplicate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The systematic review identified 36 eligible studies. Acceptance was evaluated in only one study of 60 patients, of whom only 38 agreed to endoscopy. Among the 2890 patients who received endoscopy and culture, resistances were finally determined in 86.5%. Cure rate was 72.5% in the 113 patients harboring a clarithromycin\u2010susceptible strain after previous clarithromycin treatment, 93.5% in the 765 patients harboring a metronidazole\u2010susceptible strain, and 83.8% in the 192 patients harboring a levofloxacin\u2010susceptible strain. No studies with repeated administration of levofloxacin or metronidazole were found.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Even if the culture shows a clarithromycin\u2010sensitive strain, repeating clarithromycin after a first failure should be discouraged. Susceptibility\u2010guided treatment alone did not achieve adequate cure rates for rescue therapies. Additional measures are needed to design rescue treatments that consistently achieve excellent cure rates.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hel.12584","type":"journal-article","created":{"date-parts":[[2019,4,16]],"date-time":"2019-04-16T15:50:29Z","timestamp":1555429829000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Systematic review: Would susceptibility\u2010guided treatment achieve acceptable cure rates for second\u2010line <i>Helicobacter pylori<\/i> therapy as currently practiced?"],"prefix":"10.1111","volume":"24","author":[{"given":"Mireia","family":"Baylina","sequence":"first","affiliation":[{"name":"Internal Medicine Departament Parc Taul\u00ed University Sanitary Corporation Sabadell Spain"},{"name":"Department of Medicine Autonomous University of Barcelona Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4039-1478","authenticated-orcid":false,"given":"Neus","family":"Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Internal Medicine Departament Parc Taul\u00ed University Sanitary Corporation Sabadell Spain"},{"name":"Department of Medicine Autonomous University of Barcelona Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordi","family":"S\u00e1nchez\u2010Delgado","sequence":"additional","affiliation":[{"name":"Department of Medicine Autonomous University of Barcelona Barcelona Spain"},{"name":"Digestive Diseases Unit Parc Taul\u00ed University Sanitary Corporation Sabadell Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheila","family":"L\u00f3pez\u2010G\u00f3ngora","sequence":"additional","affiliation":[{"name":"Internal Medicine Departament Parc Taul\u00ed University Sanitary Corporation Sabadell Spain"},{"name":"Department of Medicine Autonomous University of Barcelona Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xavier","family":"Calvet","sequence":"additional","affiliation":[{"name":"Department of Medicine Autonomous University of Barcelona Barcelona Spain"},{"name":"Digestive Diseases Unit Parc Taul\u00ed University Sanitary Corporation Sabadell Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9059-8602","authenticated-orcid":false,"given":"Ignasi","family":"Puig","sequence":"additional","affiliation":[{"name":"Althaia University Assistance Network of Manresa Barcelona Spain"},{"name":"International University of Catalonia Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,4,16]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1001110"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v17.i35.3971"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8553(05)70139-4"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2012-302084"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2012-302254"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2016-312288"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.04.006"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.563"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gastrohep.2016.05.003"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkv155"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/hel.12488"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2009.192757"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.06.006"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.15.2008"},{"key":"e_1_2_7_16_1","unstructured":"HigginsJPT CochraneGreen S.Handbook for systematic reviews of interventions. 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