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Clarithromycin-Resistant Genotypes and Eradication of Helicobacter pylori

Vincenzo De Francesco, MD; Marcella Margiotta, BSc; Angelo Zullo, MD; Cesare Hassan, MD; Laura Troiani, MD; Osvaldo Burattini, MD; Francesca Stella, MD; Alfredo Di Leo, MD; Francesco Russo, MD; Stefania Marangi, MD; Rosa Monno, MD; Vincenzo Stoppino, MD; Sergio Morini, MD; Carmine Panella, MD; and Enzo Ierardi, MD
[+] Article and Author Information

From Ospedali Riuniti and University of Foggia, Foggia, Italy; University of Bari, Bari, Italy; Ospedale Nuovo Regina Margherita and “San Giacomo” Hospital, Rome, Italy; and IRCSS De Bellis, Castellana Grotte, Italy.


Grant Support: The University of Foggia provided funding for reagents, and the University of Bari provided the instruments for the real-time PCR analysis.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Enzo Ierardi, MD, Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Ospedali Riuniti, Viale L. Pinto, 71100 Foggia, Italy; e-mail, e.ierardi@virgilio.it.

Current Author Addresses: Drs. De Francesco and Stoppino: Gastroenterology Unit, Ospedali Riuniti, Viale L. Pinto, 71100 Foggia, Italy.

Ms. Margiotta and Drs. Troiani, Burattini, Di Leo, and Marangi: Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Viale L. Ennio, 70124 Bari, Italy.

Drs. Zullo, Hassan, Stella, and Morini: Gastroenterology and Digestive Endoscopy Unit, Ospedale Nuovo Regina Margherita, Via Morosini, 00165 Rome, Italy.

Dr. Russo: Biochemistry Laboratory, IRCSS De Bellis, Viale L. Resistenza, 70100 Castellana Grotte, Italy.

Dr. Monno: Section of Hygiene, Department of Public Health, University of Bari, Viale L. Ennio, 70124 Bari, Italy.

Drs. Panella and Ierardi: Section of Gastroenterology, Department of Medical Sciences, Ospedali Riuniti, Viale L. Pinto, 71100 Foggia, Italy.

Author Contributions: Conception and design: V. De Francesco, A. Zullo, C. Hassan, E. Ierardi.

Analysis and interpretation of the data: V. De Francesco, A. Zullo, E. Ierardi.

Drafting of the article: V. De Francesco, M. Margiotta, A. Zullo, C. Hassan.

Critical revision of the article for important intellectual content: C. Hassan, E. Ierardi.

Final approval of the article: A. Di Leo, R. Monno, V. Stoppino, S. Morini, C. Panella, E. Ierardi.

Provision of study materials or patients: M. Margiotta, R. Monno.

Statistical expertise: V. De Francesco, A. Zullo.

Obtaining of funding: A. Di Leo.

Administrative, technical, or logistic support: M. Margiotta, L. Troiani, O. Burattini, F. Stella, F. Russo, S. Marangi, R. Monno.

Collection and assembly of data: M. Margiotta, C. Hassan, L. Troiani, O. Burattini, F. Stella, F. Russo, S. Marangi.


Ann Intern Med. 2006;144(2):94-100. doi:10.7326/0003-4819-144-2-200601170-00006
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Clarithromycin is the most powerful antibiotic that is currently available for H. pylori infection, and its use in first-line therapy regimens is endorsed by European and U.S. guidelines (34). Helicobacter pylori clarithromycin resistance is the main factor hampering the efficacy of standard triple therapies, and it is increasing worldwide (7). Indeed, the overall prevalence of primary clarithromycin resistance that we found (24%) would seem higher than that computed in previous Italian studies (range, 1.8% to 14.0%) (2325) and is similar to that detected in another recent study (23%) (26). We also confirm that the probability of success of a standard therapy regimen is markedly reduced by clarithromycin resistance to values less than 45%, which is similar to 2 large pooled data analyses (56) that calculated a mean eradication rate ranging from 18% to 44%.

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Figure.
Flow chart showing data of patients recruited in this substudy from the previous multicenter study.

NUD = nonulcer dyspepsia; PU = peptic ulcer.

Grahic Jump Location

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