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pylori</span> infection&#46; In patients with gastritis associated with <span class="elsevierStyleItalic">H&#46; pylori</span> in absence of peptic ulcer disease&#44; the decision whether to use eradication therapy will be made on a case-by-case basis in agreement with the patient and the family&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Antibiotic resistance is the main factor that affects the efficacy of current eradication regimens&#46; The prevalence of drug resistance varies based on the geographical area&#44; patient age&#44; previous administration of eradication regimens and antibiotic use in the general population&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> Since antibiotic resistance is an ever-changing phenomenon that differs between geographical areas&#44; it is important to carry out epidemiological surveillance studies to obtain updated prevalence data to help clinicians select the best possible treatment&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The primary objective of our study was to describe the pattern of antibiotic resistance in paediatric cases of infection by <span class="elsevierStyleItalic">H&#46; pylori</span>&#46; Our secondary objectives were to describe the rate of eradication in patients treated based on results of antimicrobial susceptibility testing in adherence with the current recommendations of the European Society of Paediatric Gastroenterology&#44; Hepatology and Nutrition &#40;ESPGHAN&#41; at each given time&#44; and to identify risk factors associated with failed eradication&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Sample and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We conducted a retrospective observational study including all patients aged 5&#8211;17 years given a diagnosis of <span class="elsevierStyleItalic">H&#46; pylori</span> infection between January 2014 and December 2019 that underwent a gastroscopy and culture of a gastric biopsy with isolation of <span class="elsevierStyleItalic">H&#46; pylori</span> and antibiotic susceptibility testing&#44; whether or not they underwent treatment or testing for assessment of eradication&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Samples were cultured in medium selective for <span class="elsevierStyleItalic">H&#46; pylori</span> &#40;PYL&#44; <span class="elsevierStyleItalic">BioMerieux</span>&#44; France&#41;&#46; Antibiotic susceptibility testing was performed with Etest strips &#40;<span class="elsevierStyleItalic">BioMerieux</span>&#44; France&#41;&#46; We established antibiotic susceptibility based on the minimum inhibitory concentration &#40;MIC&#41; values proposed as cut-off points in 2011 by the European Committee on Antimicrobial Susceptibility Testing &#40;EUCAST&#41;&#58; amoxicillin&#44; &#62;0&#46;12&#8239;mg&#47;L&#59; clarithromycin&#44; &#62;0&#46;5&#8239;mg&#47;L&#59; metronidazole&#44; &#62;8&#8239;mg&#47;L&#59; levofloxacin&#44; &#62;1&#8239;mg&#47;L&#59; tetracycline&#44; &#62;1&#8239;mg&#47;L&#59; rifampicin&#44; &#62;1&#8239;mg&#47;L&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In patients who received it&#44; treatment was selected based on the antibiotic results and in adherence with current ESPGHAN guidelines&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The assessment of eradication was performed with a 13C urea breath test &#40;UBTest Otsuka Pharma&#41; or a monoclonal antibody-based stool antigen test &#40;<span class="elsevierStyleItalic">H&#46; pylori</span> Turbidimetr&#237;a&#44; Materlab&#41; 6&#8211;8 weeks after completion of treatment&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We collected demographic data&#44; such as age&#44; sex and country of birth&#44; and clinical data&#44; including symptoms&#44; comorbidities&#44; previous treatment&#44; endoscopic findings&#44; drug resistance profiles and eradication rates&#46; We considered drug resistance primary if patients had not undergone eradication therapy in the past&#44; and secondary when they had undergone treatment without success before performance of the culture&#46; We defined double resistance as resistance to clarithromycin and metronidazole&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We conducted a descriptive analysis&#44; summarising qualitative variables as frequency and percentage distributions and quantitative variables as mean and standard deviation or median and interquartile range&#46; The primary endpoint was the frequency of drug resistance calculated with the corresponding 95&#37; Wilson interval&#46; We performed an exploratory univariate analysis to identify factors associated with the presence of drug resistance and with eradication&#46; We compared qualitative variables by means of the chi square test or Fisher exact test and qualitative variables by means of the Student <span class="elsevierStyleItalic">t</span> test for independent samples or the nonparametric Mann-Whitney <span class="elsevierStyleItalic">U</span> test&#44; depending on the shape of the distribution&#46; All tests were bilateral&#44; and statistical significance was defined as a <span class="elsevierStyleItalic">p-</span>value of less than 0&#46;05&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Ethical considerations&#58;</span> the study protocol was reviewed and approved by the Ethics Committee on Clinical Research with Drugs &#40;CEIm&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The study included 80 patients &#40;2014&#58; <span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;12&#59; 2015&#58; <span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;15&#59; 2016&#58; <span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;15&#59; 2017&#58; <span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;9&#59; 2018&#58; <span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;15&#59; 2019&#58; <span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;14&#41;&#44; 63&#46;8&#37; of who were female&#46; The mean age at diagnosis was 11&#46;9 years &#40;SD&#44; &#177;2&#46;7&#41;&#46; In 82&#46;5&#37; of cases&#44; the country of birth was Spain&#44; while 7&#46;5&#37; of patients were from Eastern Europe&#44; 3&#46;7&#37; from South America&#44; 3&#46;7&#37; from North Africa and 2&#46;5&#37; from Asia&#46; The most frequent presenting complaint was epigastric pain &#40;57&#46;5&#37;&#41;&#44; followed by pain in other abdominal regions &#40;22&#46;5&#37;&#41;&#44; nausea&#47;vomiting &#40;5&#37;&#41; and refractory iron-deficiency anaemia &#40;2&#46;5&#37;&#41;&#46; In 12&#46;5&#37; of patients&#44; the infection manifested with other symptoms or was a chance finding after performance of an endoscopic examination for other reasons&#46; The most frequent gastrointestinal comorbidities were gastro-oesophageal reflux &#40;13&#46;7&#37;&#41;&#44; coeliac disease &#40;7&#46;5&#37;&#41; and eosinophilic oesophagitis &#40;5&#37;&#41;&#46; In 10&#37; of patients&#44; the endoscopic examination found peptic ulcers described as gastric or duodenal erosions or ulcers&#46; There was a history of previous failed <span class="elsevierStyleItalic">H&#46; pylori</span> therapy in 38&#46;8&#37; of the patients&#46; Seventy-four of the patients &#40;92&#46;5&#37;&#41; received eradication therapy after the endoscopy and culture&#44; which varied based on the results of antibiotic susceptibility testing&#46; All patients that received treatment underwent testing to assess the success of eradication 6&#8211;8 weeks after completion of the regimen&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Overall&#44; during the study period&#44; 67&#46;5&#37; of patients &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;54&#59; 95&#37; confidence interval &#91;CI&#93;&#44; 56&#46;6&#37;&#8211;76&#46;8&#37;&#41; had strains that were resistant to at least one drug&#58; clarithromycin in 52&#46;5&#37; &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;42&#59; 95&#37; CI&#44; 41&#46;7&#37;&#8211;63&#46;1&#37;&#41;&#44; metronidazole in 31&#46;3&#37; &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;25&#59; 95&#37; CI&#44; 22&#46;2&#37;&#8211;42&#46;1&#37;&#41;&#44; levofloxacin in 7&#46;9&#37; &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;5&#47;63&#59; 95&#37; CI&#44; 3&#46;4&#37;&#8211;17&#46;3&#37;&#41;&#44; amoxicillin in 7&#46;5&#37; &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;6&#59; 95&#37; CI&#44; 3&#46;5&#37;&#8211;15&#46;4&#37;&#41;&#46; Double resistance to clarithromycin and metronidazole was found in 16&#46;3&#37; &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;13&#59; 95&#37; CI&#44; 9&#46;8&#37;&#8211;25&#46;8&#37;&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Patients that had not received eradication therapy in the past were less likely to be infected by resistant strains compared to those that had undergone treatment unsuccessfully &#40;primary resistance&#44; 57&#46;1&#37; vs secondary resistance&#44; 83&#46;9&#37;&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;01&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; A greater proportion of patients born in Spain had strains resistant to at least one drug and there was also a significantly greater proportion of these patients with clarithromycin-resistant strains compared to patients born outside of Spain&#44; none of whom had strains resistant to this antibiotic &#40;63&#46;6&#37; vs 0&#37;&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;001&#41;&#46; When it came to all other antibiotics&#44; we did not find significant differences in the prevalence of drug resistance based on patient sex&#44; age or country of birth &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">When we analysed the temporal trends in drug resistance throughout the study period&#44; we did not find any significant changes during these years &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">All patients that were treated received treatment guided by the results of antimicrobial susceptibility testing and in adherence with the current ESPGHAN recommendations&#46; The overall success rate of eradication therapy was 65&#46;8&#37;&#44; with a higher proportion of successful eradication in patients that had not been treated previously &#40;71&#46;1&#37; vs 57&#46;1&#37;&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;31&#41;&#46; Furthermore&#44; the rate of eradication was lower in patients infected by double-resistant strains compared to the rest of patients &#40;50&#37; vs&#46; 68&#46;9&#37;&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;0&#46;31&#41;&#46; In patients treated in adherence with the new ESPGHAN guidelines from 2017&#44; the eradication success rate was significantly higher compared to patients treated according to earlier recommendations &#40;80&#37; vs 55&#46;8&#37;&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;04&#41;&#46; The eradication success rate in patients treated in the last year under study &#40;2019&#41; was 100&#37; &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;12&#47;12&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">We found a very high prevalence of antibiotic resistance in our region during the period under study&#44; comparable to the prevalence previously described in Spain&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;14</span></a> The prevalence of resistance to different drugs remained stable in the period under study and were similar to the figures reported in other countries in Southern Europe&#44; where resistance to clarithromycin is noticeably more frequent compared to the rest of Europe&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;18</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">As for the risk factors for the presence of drug resistance&#44; we found that prior failure of eradication therapy was a clear predictor of resistance&#46; Therefore&#44; in cases in which treatment is indicated&#44; it is essential to prescribe treatment based on antibiotic susceptibility test results to prevent treatment failure and the development of secondary drug resistance&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Primary resistance to clarithromycin is markedly more prevalent in children &#40;44&#46;9&#37;&#41; compared to the prevalence described in adults in our region &#40;14&#46;7&#37;&#8211;22&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;23</span></a> The higher prevalence of primary resistance in children compared to adults suggests in vivo drug resistance development during childhood&#46; The alarming frequency of clarithromycin resistance in patients that had not undergone eradication therapy in the past may be explained by the growing use of macrolides commonly used for empirical treatment of <span class="elsevierStyleItalic">H&#46; pylori</span> and other common infections of childhood&#44; chiefly of the respiratory tract&#46; Clarithromycin should never be used as first-line treatment if culture or antimicrobial susceptibility testing has not been performed or <span class="elsevierStyleItalic">H&#46; pylori</span> failed to grow in culture&#44; as the prevalence of resistance far exceeds 20&#37;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">On the other hand&#44; primary resistance to metronidazole and levofloxacin are clearly less prevalent compared to the prevalence found in studies conducted in adults in our region &#40;16&#46;3&#37; vs 27&#37;&#8211;40&#37; and 7&#46;9&#37; vs 13&#46;9&#37;&#8211;38&#37;&#44; respectively&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;23</span></a> Although quinolones have not been authorised for use in the paediatric population&#44; the prevalence of primary resistance to levofloxacin in children is considerable &#40;7&#46;9&#37;&#41;&#44; which may be due to resistance in the causative strain and transmission of infection within the household from adults to children&#46; Children most frequently acquire <span class="elsevierStyleItalic">H&#46; pylori</span> from an infected parent&#44; usually the mother&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The prevalence of peptic ulcer disease in our study was 10&#37;&#46; This was consistent with the findings of a European multicentre study of drug resistance&#44; which found evidence of ulcerative lesions in 6&#46;8&#37; of patients and 10&#46;4&#37; of those aged more than 11&#8239;years&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The new ESPGHAN guidelines for the management of infection by <span class="elsevierStyleItalic">H&#46; pylori</span> in children and adolescents were published in June 2017&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> These guidelines underscore that the main goal of the medical evaluation of children with gastrointestinal symptoms should be to determine the underlying cause of the symptoms&#44; and not just to assess for the presence of <span class="elsevierStyleItalic">H&#46; pylori</span> infection&#46; They discourage testing for detection of <span class="elsevierStyleItalic">H&#46; pylori</span> in children with functional abdominal pain&#44; as well as &#8220;test and treat&#8221; approaches &#40;non-invasive diagnosis and treatment&#41;&#44; contrary to management guidelines for adults&#46; The recommended approach to diagnosis of infection by <span class="elsevierStyleItalic">H&#46; pylori</span> in children is through invasive testing&#44; with performance of an endoscopic examination&#44; gastric biopsy and culture&#46; Eradication treatment&#44; when indicated&#44; should be prescribed based on the results of antimicrobial susceptibility testing&#46; The new guidelines proposed significant changes to pharmacological treatment compared to previous guidelines&#44; including longer duration of treatment and higher doses of proton pump inhibitors &#40;PPIs&#41;&#44; especially in young children &#40;dose of 1&#46;5&#8211;2&#46;5&#8239;mg&#47;kg&#47;day&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">When we analysed whether these new treatment recommendations resulted in improved eradication success rates&#44; we found a significant increase in successful eradication in patients treated in adherence with the updated ESPGHAN guidelines&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">To avoid development of secondary drug resistance in <span class="elsevierStyleItalic">H&#46; pylori</span> strains involved in infections&#44; the eradication success rate has to exceed 90&#37; in the per-protocol analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> However&#44; this target is rarely met in most recent paediatric trials&#46; In our study&#44; while we observed a significant improvement in eradication rates in recent years&#44; they were still below the desired target&#46; Several factors may play a key role in this outcome&#44; such as the high prevalence of antimicrobial resistance and the sizeable proportion of patients in our region infected by double-resistant strains&#44; a subset in which the rate of successful eradication is lower&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The growing number of paediatric patients infected with multidrug-resistant strains warrants a revision of current treatment regimens&#46; Second-line antibiotics&#44; such as quinolones or tetracycline&#44; are not authorised for use in the paediatric population or only authorised starting at a certain age&#46; Rifabutin has been used successfully in adults&#44; but may cause drug resistance problems in the treatment of tuberculosis&#44; so treatment options in these patients are very limited&#46; Since in vitro resistance to metronidazole can be overcome in vivo using very high doses and prolonged courses of treatment&#44; a European multicentre study analysed the frequency of successful eradication and the side effects of a 2-week course of high-dose triple therapy &#40;amoxicillin at &#8764;75&#8239;mg&#47;kg&#47;day&#44; metronidazole at &#8764;25&#8239;mg&#47;kg&#47;day and esomeprazole at &#8764;1&#46;5&#8239;mg&#47;kg&#47;day&#41; in paediatric patients with infection by double-resistant strains confirmed by culture&#46; The study found a rate of successful eradication of 66&#37; in the intention-to-treat analysis &#40;95&#37; CI&#44; 54&#37;&#8211;78&#37;&#41; and of 73&#37; in the per-protocol analysis &#40;95&#37; CI&#44; 60&#37;&#8211;86&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Although these rates are better compared to previous studies&#44; they are still far from the established target&#46; It must be taken into account that this study was conducted before the publication of the current guidelines and used lower PPI doses &#40;&#8764;1&#46;5&#8239;mg&#47;kg&#47;day&#41; than currently recommended e &#40;1&#46;5&#8211;2&#46;5&#8239;mg&#47;kg&#47;day&#41;&#46; The current guidelines recommend treatment of infection by double-resistant strains with a 14-day course of high-dose triple therapy &#40;PPI-amoxicillin-metronidazole&#41; or quadruple therapy with bismuth &#40;age&#8239;&#60;&#8239;8 years&#58; bismuth-PPI-amoxicillin-metronidazole&#59; age&#8239;&#62;&#8239;8 years&#58; bismuth-PPI-metronidazole-tetracycline&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Besides antibiotic resistance in <span class="elsevierStyleItalic">H&#46; pylori</span>&#44; there are other possible reasons for treatment failure&#44; such as lack of adherence&#44; inadequate dosage or duration of treatment&#44; rapid metabolising of certain PPIs&#44; bacterial virulence factors&#44; ineffective penetration of antibiotics in the gastric mucosa and inactivation of antibiotics at low gastric pH&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A recent study analysed the role of adherence in treatment failure in paediatric patients that received treatment tailored to antimicrobial susceptibility&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> The study found that eradication in children with a concordance between prescribed and ingested drugs above 90&#37; was successful in 89&#46;9&#37; of the patients&#44; compared to 36&#46;8&#37; of the patients who did not adhere to treatment&#46; Therefore&#44; it is essential that patients and their families are informed of the importance of adequate adherence to treatment&#44; as it can have a significant impact in improving the rate of successful eradication&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The high prevalence of antimicrobial resistance in <span class="elsevierStyleItalic">H&#46; pylori</span> and&#44; therefore&#44; the low frequency of successful eradication&#44; continue to be a significant concern&#46; Therefore&#44; prescription of first-line treatment should be tailored to antimicrobial susceptibility and&#44; in cases in which susceptibility testing is not available or cannot be performed&#44; based on the known regional prevalence of antimicrobial resistance&#46; Correct implementation of the most recent guidelines significantly improves the rate of successful eradication&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The resistance to antibiotics of <span class="elsevierStyleItalic">Helicobacter pylori</span> &#40;<span class="elsevierStyleItalic">H&#46; pylori</span>&#41; is the main factor that affects current therapeutic treatments&#46; The main objective of this study is to describe the pattern of antibiotic resistances in children with an infection due to <span class="elsevierStyleItalic">H&#46; pylori</span>&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">An observational&#44; retrospective study was conducted from 2014 to 2019&#44; which included patients between 5 and 17 years old&#44; on whom a gastroscopy&#44; with a gastric biopsy culture positive for <span class="elsevierStyleItalic">H&#46; pylori</span>&#44; and an antibiotic sensitivity study was performed&#46; The antibiotic sensitivity studies were performed using an epsilometer &#40;E-test&#41;&#46; The cut-off points to define the resistances were those proposed by the European Committee on Antimicrobial Susceptibility Testing &#8212; EUCAST&#46; The eradication study was performed using the 13C-urea breath test or the <span class="elsevierStyleItalic">H&#46; pylori</span> monoclonal test in faeces 6&#8211;8 weeks after finalising the treatment&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The study included 80 patients &#40;63&#46;8&#37; females&#41;&#44; with a mean age of 11&#46;9 years &#40;SD&#8239;&#177;&#8239;2&#46;7 DS&#41;&#46; Over one-third &#40;38&#46;8&#37;&#41; of the patients had received previous treatment for <span class="elsevierStyleItalic">H&#46; pylori</span>&#46; In the endoscopy&#44; peptic ulcer lesions were observed in 10&#37; of patients&#46; More than two-thirds &#40;67&#46;5&#37;&#41; had resistance to at least one drug&#46; 16&#46;3&#37; presented double resistance&#46; The primary resistances were&#58; clarithromycin&#44; 44&#46;9&#37;&#44; metronidazole 16&#46;3&#37;&#44; levofloxacine 7&#46;9&#37;&#44; and amoxicillin 2&#37;&#46; Patients that received treatment according to the new ESPGHAN 2017 guidelines had significantly higher eradication rates compared to those that received treatment according to previous guidelines &#40;80&#37; vs&#46; 55&#46;8&#37;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;04&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The high rate of <span class="elsevierStyleItalic">H&#46; pylori</span> resistances&#44; and as a result&#44; the low eradication rates&#44; are still a very important cause for concern&#46; The first line treatment&#44; when this is indicated must be given following the antibiotic sensitivity studies&#44; and in the cases where these cannot be done or are not available&#44; at least in accordance with the regional resistance rates&#46; The correct application of the new guidelines significantly improves the eradication rate&#46;</p></span>"
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            "identificador" => "abst0005"
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          1 => array:2 [
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            "titulo" => "Patients and methods"
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            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las resistencias antibi&#243;ticas de <span class="elsevierStyleItalic">Helicobacter pylori</span> &#40;<span class="elsevierStyleItalic">H&#46; pylori</span>&#41; son el principal factor que afecta a la eficacia de los reg&#237;menes terap&#233;uticos actuales&#46; El objetivo principal del estudio es describir el patr&#243;n de resistencias antibi&#243;ticas en ni&#732;nos con infecci&#243;n por <span class="elsevierStyleItalic">H&#46; pylori</span>&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo de 2014 a 2019 en el que se incluyen pacientes entre 5&#8211;17 a&#241;os a los que se realiz&#243; gastroscopia&#44; con cultivo de biopsia g&#225;stricapositivo para <span class="elsevierStyleItalic">H&#46; pylori</span> y estudio de sensibilidad a antibi&#243;ticos&#46; Los estudios de sensibilidad antibi&#243;tica se realizaron mediante E-test&#46; Los puntos de corte para definir las resistencias fueron los propuestos por el EUCAST&#46; El estudio de erradicaci&#243;n se realiz&#243; con test del aliento con urea marcada con C 13 o test monoclonal de ant&#237;geno de <span class="elsevierStyleItalic">H&#46; pylori</span> en heces a las 6&#8211;8 semanas de finalizar el tratamiento&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Ochenta pacientes &#40;63&#44;8&#37; mujeres&#41;&#46; Media de edad 11&#44;9 a&#241;os &#40;&#177;2&#44;7 DS&#41;&#46; Un 38&#44;8&#37; hab&#237;an recibido tratamiento previo para H&#46; pylori&#46; Un 10&#37; presentaron en la endoscopia lesiones ulcerosas p&#233;pticas&#46; El 67&#44;5&#37; presentaba resistencia al menos a un f&#225;rmaco&#46; Un 16&#44;3&#37; presentaron doble resistencia&#46; Las resistencias primarias fueron&#58; claritromicina 44&#44;9&#37;&#44; metronidazol 16&#44;3&#37;&#44; levofloxacino 7&#44;9&#37; y amoxicilina 2&#37;&#46; Los pacientes que recibieron tratamiento acorde a las nuevas gu&#237;as ESPGHAN 2017 presentaron tasas de erradicaci&#243;n significativamente superiores en comparaci&#243;n con los que recibieron tratamiento acorde a las gu&#237;as previas &#40;80&#37; vs&#46; 55&#44;8&#37; p&#8239;&#61;&#8239;0&#44;04&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La alta tasa de resistencias de <span class="elsevierStyleItalic">H&#46; pylori</span> y&#44; en consecuencia&#44; las bajas tasas de erradicaci&#243;n&#44; siguen siendo una preocupaci&#243;n muy importante&#46; El tratamiento de primera l&#237;nea&#44; cuando est&#233; indicado debe hacerse guiado por estudios de sensibilidad antibi&#243;tica y en los casos en el que no se puedan realizar o no est&#233;n disponibles&#44; al menos de acuerdo con las tasas regionales de resistencia&#46; La aplicaci&#243;n correcta de las nuevas gu&#237;as mejora de forma significativa el nivel de erradicaci&#243;n&#46;</p></span>"
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          1 => array:2 [
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            "titulo" => "Pacientes y m&#233;todos"
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          2 => array:2 [
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            "titulo" => "Conclusiones"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Botija G&#44; Garc&#237;a Rodr&#237;guez C&#44; Recio Linares A&#44; Campelo Guti&#233;rrez C&#44; P&#233;rez-Fern&#225;ndez E&#44; Barrio Merino A&#46; Resistencias antibi&#243;ticas y tasas de erradicaci&#243;n en infecci&#243;n por <span class="elsevierStyleItalic">Helicobacter pylori</span>&#46; An Pediatr &#40;Barc&#41;&#46; 2021&#59;95&#58;431&#8211;437&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Previous presentation&#58; preliminary results of the study were presented as a brief oral communication at the congresses of the Sociedad Espa&#241;ola de Gastroenterolog&#237;a&#44; Hepatolog&#237;a y Nutrici&#243;n Pedi&#225;trica &#40;SEGHNP&#41; held in Gijon&#44; Spain&#44; in 2016 and in Santander&#44; Spain&#44; in 2019&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Temporal trends in antimicrobial resistance&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;31</th><th class="td" title="\n
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                  \t\t\t\t">Amoxicillin&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Clarithromycin&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Metronidazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">31&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Double resistance&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Levofloxacin &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;63&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">11&#46;7&#8239;&#177;&#8239;2&#46;6</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">31&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;775&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;0&#46;1-6&#93;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Clarithromycin</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;4&#8239;&#177;&#8239;2&#46;7</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;4&#8239;&#177;&#8239;2&#46;6</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;133&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Born in Spain</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Previous treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;0&#46;1-6&#93;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Metronidazole</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;2&#8239;&#177;&#8239;2&#46;5</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;3&#8239;&#177;&#8239;2&#46;9</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;188&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;975&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Born in Spain</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;755&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Previous treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Double resistance</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;9&#8239;&#177;&#8239;2&#46;6</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;9&#8239;&#177;&#8239;3&#46;1</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;969&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Born in Spain</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Previous treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Risk factors for development of resistance&#46;</p>"
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        0 => array:2 [
          "identificador" => "bibs0005"
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            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global prevalence of <span class="elsevierStyleItalic">Helicobacter pylori</span> infection&#58; systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;K&#46;Y&#46; Hooi"
                            1 => "W&#46;J&#46; Lai"
                            2 => "W&#46;K&#46; Ng"
                            3 => "M&#46;M&#46;Y&#46; Suen"
                            4 => "F&#46;E&#46; Underwood"
                            5 => "D&#46; Tanyingoh"
                          ]
                        ]
                      ]
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                    0 => array:2 [
                      "doi" => "10.1053/j.gastro.2017.04.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2017"
                        "volumen" => "153"
                        "paginaInicial" => "420"
                        "paginaFinal" => "429"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28456631"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0010"
              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recurrence of <span class="elsevierStyleItalic">Helicobacter pylori</span> infection in Bolivian children and adults after a population-based &#8220;screen and treat&#8221; strategy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Sivapalasingam"
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Original Article
Antibiotic resistances and eradication rates in Helicobacter pylori infection
Resistencias antibióticas y tasas de erradicación en infección por Helicobacter pylori
Gonzalo Botija
Corresponding author
gbotija@fhalcorcon.es

Corresponding author.
, Clara García Rodríguez, Aránzazu Recio Linares, Carolina Campelo Gutiérrez, Elia Pérez-Fernández, Alfonso Barrio Merino
Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">It is estimated that infection with <span class="elsevierStyleItalic">Helicobacter pylori</span> &#40;<span class="elsevierStyleItalic">H&#46; pylori</span>&#41; affects approximately 50&#37; of the global population and plays a key role in the development of several gastrointestinal diseases&#44; such as chronic gastritis&#44; peptic ulcer and stomach cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The infection is usually acquired in childhood&#44; but&#44; compared to adults&#44; children are unlikely to develop complications&#46; Furthermore&#44; recurrence after successful eradication may be fairly frequent in children &#40;recurrence within 1&#8239;year of up to 20&#37; in children under 10&#8239;years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Recommendations for diagnosis and treatment in children and adolescents differ from adult guidelines because the risk-benefit ratio changes based on age&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In children&#44; in absence of peptic ulcer disease&#44; defined as development of gastric or duodenal sores and ulcers&#44; eradication of <span class="elsevierStyleItalic">H&#46; pylori</span> is not associated with symptom improvement&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> The main objective in children with gastrointestinal symptoms should be to assess for potential underlying causes and not just colonization by <span class="elsevierStyleItalic">H&#46; pylori&#46;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Contrary to the management in adults&#44; the &#8220;test and treat&#8221; strategy &#40;non-invasive diagnostic testing and treatment&#41; is not indicated in paediatric patients&#46; Invasive diagnosis by means of an endoscopic examination is only indicated in patients with suspected peptic ulcer disease&#46; Treatment is indicated in patients with confirmed peptic ulcer disuse associated with <span class="elsevierStyleItalic">H&#46; pylori</span> infection&#46; In patients with gastritis associated with <span class="elsevierStyleItalic">H&#46; pylori</span> in absence of peptic ulcer disease&#44; the decision whether to use eradication therapy will be made on a case-by-case basis in agreement with the patient and the family&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Antibiotic resistance is the main factor that affects the efficacy of current eradication regimens&#46; The prevalence of drug resistance varies based on the geographical area&#44; patient age&#44; previous administration of eradication regimens and antibiotic use in the general population&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> Since antibiotic resistance is an ever-changing phenomenon that differs between geographical areas&#44; it is important to carry out epidemiological surveillance studies to obtain updated prevalence data to help clinicians select the best possible treatment&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The primary objective of our study was to describe the pattern of antibiotic resistance in paediatric cases of infection by <span class="elsevierStyleItalic">H&#46; pylori</span>&#46; Our secondary objectives were to describe the rate of eradication in patients treated based on results of antimicrobial susceptibility testing in adherence with the current recommendations of the European Society of Paediatric Gastroenterology&#44; Hepatology and Nutrition &#40;ESPGHAN&#41; at each given time&#44; and to identify risk factors associated with failed eradication&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Sample and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We conducted a retrospective observational study including all patients aged 5&#8211;17 years given a diagnosis of <span class="elsevierStyleItalic">H&#46; pylori</span> infection between January 2014 and December 2019 that underwent a gastroscopy and culture of a gastric biopsy with isolation of <span class="elsevierStyleItalic">H&#46; pylori</span> and antibiotic susceptibility testing&#44; whether or not they underwent treatment or testing for assessment of eradication&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Samples were cultured in medium selective for <span class="elsevierStyleItalic">H&#46; pylori</span> &#40;PYL&#44; <span class="elsevierStyleItalic">BioMerieux</span>&#44; France&#41;&#46; Antibiotic susceptibility testing was performed with Etest strips &#40;<span class="elsevierStyleItalic">BioMerieux</span>&#44; France&#41;&#46; We established antibiotic susceptibility based on the minimum inhibitory concentration &#40;MIC&#41; values proposed as cut-off points in 2011 by the European Committee on Antimicrobial Susceptibility Testing &#40;EUCAST&#41;&#58; amoxicillin&#44; &#62;0&#46;12&#8239;mg&#47;L&#59; clarithromycin&#44; &#62;0&#46;5&#8239;mg&#47;L&#59; metronidazole&#44; &#62;8&#8239;mg&#47;L&#59; levofloxacin&#44; &#62;1&#8239;mg&#47;L&#59; tetracycline&#44; &#62;1&#8239;mg&#47;L&#59; rifampicin&#44; &#62;1&#8239;mg&#47;L&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In patients who received it&#44; treatment was selected based on the antibiotic results and in adherence with current ESPGHAN guidelines&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The assessment of eradication was performed with a 13C urea breath test &#40;UBTest Otsuka Pharma&#41; or a monoclonal antibody-based stool antigen test &#40;<span class="elsevierStyleItalic">H&#46; pylori</span> Turbidimetr&#237;a&#44; Materlab&#41; 6&#8211;8 weeks after completion of treatment&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We collected demographic data&#44; such as age&#44; sex and country of birth&#44; and clinical data&#44; including symptoms&#44; comorbidities&#44; previous treatment&#44; endoscopic findings&#44; drug resistance profiles and eradication rates&#46; We considered drug resistance primary if patients had not undergone eradication therapy in the past&#44; and secondary when they had undergone treatment without success before performance of the culture&#46; We defined double resistance as resistance to clarithromycin and metronidazole&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We conducted a descriptive analysis&#44; summarising qualitative variables as frequency and percentage distributions and quantitative variables as mean and standard deviation or median and interquartile range&#46; The primary endpoint was the frequency of drug resistance calculated with the corresponding 95&#37; Wilson interval&#46; We performed an exploratory univariate analysis to identify factors associated with the presence of drug resistance and with eradication&#46; We compared qualitative variables by means of the chi square test or Fisher exact test and qualitative variables by means of the Student <span class="elsevierStyleItalic">t</span> test for independent samples or the nonparametric Mann-Whitney <span class="elsevierStyleItalic">U</span> test&#44; depending on the shape of the distribution&#46; All tests were bilateral&#44; and statistical significance was defined as a <span class="elsevierStyleItalic">p-</span>value of less than 0&#46;05&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Ethical considerations&#58;</span> the study protocol was reviewed and approved by the Ethics Committee on Clinical Research with Drugs &#40;CEIm&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The study included 80 patients &#40;2014&#58; <span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;12&#59; 2015&#58; <span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;15&#59; 2016&#58; <span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;15&#59; 2017&#58; <span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;9&#59; 2018&#58; <span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;15&#59; 2019&#58; <span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;14&#41;&#44; 63&#46;8&#37; of who were female&#46; The mean age at diagnosis was 11&#46;9 years &#40;SD&#44; &#177;2&#46;7&#41;&#46; In 82&#46;5&#37; of cases&#44; the country of birth was Spain&#44; while 7&#46;5&#37; of patients were from Eastern Europe&#44; 3&#46;7&#37; from South America&#44; 3&#46;7&#37; from North Africa and 2&#46;5&#37; from Asia&#46; The most frequent presenting complaint was epigastric pain &#40;57&#46;5&#37;&#41;&#44; followed by pain in other abdominal regions &#40;22&#46;5&#37;&#41;&#44; nausea&#47;vomiting &#40;5&#37;&#41; and refractory iron-deficiency anaemia &#40;2&#46;5&#37;&#41;&#46; In 12&#46;5&#37; of patients&#44; the infection manifested with other symptoms or was a chance finding after performance of an endoscopic examination for other reasons&#46; The most frequent gastrointestinal comorbidities were gastro-oesophageal reflux &#40;13&#46;7&#37;&#41;&#44; coeliac disease &#40;7&#46;5&#37;&#41; and eosinophilic oesophagitis &#40;5&#37;&#41;&#46; In 10&#37; of patients&#44; the endoscopic examination found peptic ulcers described as gastric or duodenal erosions or ulcers&#46; There was a history of previous failed <span class="elsevierStyleItalic">H&#46; pylori</span> therapy in 38&#46;8&#37; of the patients&#46; Seventy-four of the patients &#40;92&#46;5&#37;&#41; received eradication therapy after the endoscopy and culture&#44; which varied based on the results of antibiotic susceptibility testing&#46; All patients that received treatment underwent testing to assess the success of eradication 6&#8211;8 weeks after completion of the regimen&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Overall&#44; during the study period&#44; 67&#46;5&#37; of patients &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;54&#59; 95&#37; confidence interval &#91;CI&#93;&#44; 56&#46;6&#37;&#8211;76&#46;8&#37;&#41; had strains that were resistant to at least one drug&#58; clarithromycin in 52&#46;5&#37; &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;42&#59; 95&#37; CI&#44; 41&#46;7&#37;&#8211;63&#46;1&#37;&#41;&#44; metronidazole in 31&#46;3&#37; &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;25&#59; 95&#37; CI&#44; 22&#46;2&#37;&#8211;42&#46;1&#37;&#41;&#44; levofloxacin in 7&#46;9&#37; &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;5&#47;63&#59; 95&#37; CI&#44; 3&#46;4&#37;&#8211;17&#46;3&#37;&#41;&#44; amoxicillin in 7&#46;5&#37; &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;6&#59; 95&#37; CI&#44; 3&#46;5&#37;&#8211;15&#46;4&#37;&#41;&#46; Double resistance to clarithromycin and metronidazole was found in 16&#46;3&#37; &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;13&#59; 95&#37; CI&#44; 9&#46;8&#37;&#8211;25&#46;8&#37;&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Patients that had not received eradication therapy in the past were less likely to be infected by resistant strains compared to those that had undergone treatment unsuccessfully &#40;primary resistance&#44; 57&#46;1&#37; vs secondary resistance&#44; 83&#46;9&#37;&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;01&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; A greater proportion of patients born in Spain had strains resistant to at least one drug and there was also a significantly greater proportion of these patients with clarithromycin-resistant strains compared to patients born outside of Spain&#44; none of whom had strains resistant to this antibiotic &#40;63&#46;6&#37; vs 0&#37;&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;001&#41;&#46; When it came to all other antibiotics&#44; we did not find significant differences in the prevalence of drug resistance based on patient sex&#44; age or country of birth &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">When we analysed the temporal trends in drug resistance throughout the study period&#44; we did not find any significant changes during these years &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">All patients that were treated received treatment guided by the results of antimicrobial susceptibility testing and in adherence with the current ESPGHAN recommendations&#46; The overall success rate of eradication therapy was 65&#46;8&#37;&#44; with a higher proportion of successful eradication in patients that had not been treated previously &#40;71&#46;1&#37; vs 57&#46;1&#37;&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;31&#41;&#46; Furthermore&#44; the rate of eradication was lower in patients infected by double-resistant strains compared to the rest of patients &#40;50&#37; vs&#46; 68&#46;9&#37;&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;0&#46;31&#41;&#46; In patients treated in adherence with the new ESPGHAN guidelines from 2017&#44; the eradication success rate was significantly higher compared to patients treated according to earlier recommendations &#40;80&#37; vs 55&#46;8&#37;&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;04&#41;&#46; The eradication success rate in patients treated in the last year under study &#40;2019&#41; was 100&#37; &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;12&#47;12&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">We found a very high prevalence of antibiotic resistance in our region during the period under study&#44; comparable to the prevalence previously described in Spain&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;14</span></a> The prevalence of resistance to different drugs remained stable in the period under study and were similar to the figures reported in other countries in Southern Europe&#44; where resistance to clarithromycin is noticeably more frequent compared to the rest of Europe&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;18</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">As for the risk factors for the presence of drug resistance&#44; we found that prior failure of eradication therapy was a clear predictor of resistance&#46; Therefore&#44; in cases in which treatment is indicated&#44; it is essential to prescribe treatment based on antibiotic susceptibility test results to prevent treatment failure and the development of secondary drug resistance&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Primary resistance to clarithromycin is markedly more prevalent in children &#40;44&#46;9&#37;&#41; compared to the prevalence described in adults in our region &#40;14&#46;7&#37;&#8211;22&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;23</span></a> The higher prevalence of primary resistance in children compared to adults suggests in vivo drug resistance development during childhood&#46; The alarming frequency of clarithromycin resistance in patients that had not undergone eradication therapy in the past may be explained by the growing use of macrolides commonly used for empirical treatment of <span class="elsevierStyleItalic">H&#46; pylori</span> and other common infections of childhood&#44; chiefly of the respiratory tract&#46; Clarithromycin should never be used as first-line treatment if culture or antimicrobial susceptibility testing has not been performed or <span class="elsevierStyleItalic">H&#46; pylori</span> failed to grow in culture&#44; as the prevalence of resistance far exceeds 20&#37;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">On the other hand&#44; primary resistance to metronidazole and levofloxacin are clearly less prevalent compared to the prevalence found in studies conducted in adults in our region &#40;16&#46;3&#37; vs 27&#37;&#8211;40&#37; and 7&#46;9&#37; vs 13&#46;9&#37;&#8211;38&#37;&#44; respectively&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;23</span></a> Although quinolones have not been authorised for use in the paediatric population&#44; the prevalence of primary resistance to levofloxacin in children is considerable &#40;7&#46;9&#37;&#41;&#44; which may be due to resistance in the causative strain and transmission of infection within the household from adults to children&#46; Children most frequently acquire <span class="elsevierStyleItalic">H&#46; pylori</span> from an infected parent&#44; usually the mother&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The prevalence of peptic ulcer disease in our study was 10&#37;&#46; This was consistent with the findings of a European multicentre study of drug resistance&#44; which found evidence of ulcerative lesions in 6&#46;8&#37; of patients and 10&#46;4&#37; of those aged more than 11&#8239;years&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The new ESPGHAN guidelines for the management of infection by <span class="elsevierStyleItalic">H&#46; pylori</span> in children and adolescents were published in June 2017&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> These guidelines underscore that the main goal of the medical evaluation of children with gastrointestinal symptoms should be to determine the underlying cause of the symptoms&#44; and not just to assess for the presence of <span class="elsevierStyleItalic">H&#46; pylori</span> infection&#46; They discourage testing for detection of <span class="elsevierStyleItalic">H&#46; pylori</span> in children with functional abdominal pain&#44; as well as &#8220;test and treat&#8221; approaches &#40;non-invasive diagnosis and treatment&#41;&#44; contrary to management guidelines for adults&#46; The recommended approach to diagnosis of infection by <span class="elsevierStyleItalic">H&#46; pylori</span> in children is through invasive testing&#44; with performance of an endoscopic examination&#44; gastric biopsy and culture&#46; Eradication treatment&#44; when indicated&#44; should be prescribed based on the results of antimicrobial susceptibility testing&#46; The new guidelines proposed significant changes to pharmacological treatment compared to previous guidelines&#44; including longer duration of treatment and higher doses of proton pump inhibitors &#40;PPIs&#41;&#44; especially in young children &#40;dose of 1&#46;5&#8211;2&#46;5&#8239;mg&#47;kg&#47;day&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">When we analysed whether these new treatment recommendations resulted in improved eradication success rates&#44; we found a significant increase in successful eradication in patients treated in adherence with the updated ESPGHAN guidelines&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">To avoid development of secondary drug resistance in <span class="elsevierStyleItalic">H&#46; pylori</span> strains involved in infections&#44; the eradication success rate has to exceed 90&#37; in the per-protocol analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> However&#44; this target is rarely met in most recent paediatric trials&#46; In our study&#44; while we observed a significant improvement in eradication rates in recent years&#44; they were still below the desired target&#46; Several factors may play a key role in this outcome&#44; such as the high prevalence of antimicrobial resistance and the sizeable proportion of patients in our region infected by double-resistant strains&#44; a subset in which the rate of successful eradication is lower&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The growing number of paediatric patients infected with multidrug-resistant strains warrants a revision of current treatment regimens&#46; Second-line antibiotics&#44; such as quinolones or tetracycline&#44; are not authorised for use in the paediatric population or only authorised starting at a certain age&#46; Rifabutin has been used successfully in adults&#44; but may cause drug resistance problems in the treatment of tuberculosis&#44; so treatment options in these patients are very limited&#46; Since in vitro resistance to metronidazole can be overcome in vivo using very high doses and prolonged courses of treatment&#44; a European multicentre study analysed the frequency of successful eradication and the side effects of a 2-week course of high-dose triple therapy &#40;amoxicillin at &#8764;75&#8239;mg&#47;kg&#47;day&#44; metronidazole at &#8764;25&#8239;mg&#47;kg&#47;day and esomeprazole at &#8764;1&#46;5&#8239;mg&#47;kg&#47;day&#41; in paediatric patients with infection by double-resistant strains confirmed by culture&#46; The study found a rate of successful eradication of 66&#37; in the intention-to-treat analysis &#40;95&#37; CI&#44; 54&#37;&#8211;78&#37;&#41; and of 73&#37; in the per-protocol analysis &#40;95&#37; CI&#44; 60&#37;&#8211;86&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Although these rates are better compared to previous studies&#44; they are still far from the established target&#46; It must be taken into account that this study was conducted before the publication of the current guidelines and used lower PPI doses &#40;&#8764;1&#46;5&#8239;mg&#47;kg&#47;day&#41; than currently recommended e &#40;1&#46;5&#8211;2&#46;5&#8239;mg&#47;kg&#47;day&#41;&#46; The current guidelines recommend treatment of infection by double-resistant strains with a 14-day course of high-dose triple therapy &#40;PPI-amoxicillin-metronidazole&#41; or quadruple therapy with bismuth &#40;age&#8239;&#60;&#8239;8 years&#58; bismuth-PPI-amoxicillin-metronidazole&#59; age&#8239;&#62;&#8239;8 years&#58; bismuth-PPI-metronidazole-tetracycline&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Besides antibiotic resistance in <span class="elsevierStyleItalic">H&#46; pylori</span>&#44; there are other possible reasons for treatment failure&#44; such as lack of adherence&#44; inadequate dosage or duration of treatment&#44; rapid metabolising of certain PPIs&#44; bacterial virulence factors&#44; ineffective penetration of antibiotics in the gastric mucosa and inactivation of antibiotics at low gastric pH&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A recent study analysed the role of adherence in treatment failure in paediatric patients that received treatment tailored to antimicrobial susceptibility&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> The study found that eradication in children with a concordance between prescribed and ingested drugs above 90&#37; was successful in 89&#46;9&#37; of the patients&#44; compared to 36&#46;8&#37; of the patients who did not adhere to treatment&#46; Therefore&#44; it is essential that patients and their families are informed of the importance of adequate adherence to treatment&#44; as it can have a significant impact in improving the rate of successful eradication&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The high prevalence of antimicrobial resistance in <span class="elsevierStyleItalic">H&#46; pylori</span> and&#44; therefore&#44; the low frequency of successful eradication&#44; continue to be a significant concern&#46; Therefore&#44; prescription of first-line treatment should be tailored to antimicrobial susceptibility and&#44; in cases in which susceptibility testing is not available or cannot be performed&#44; based on the known regional prevalence of antimicrobial resistance&#46; Correct implementation of the most recent guidelines significantly improves the rate of successful eradication&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The resistance to antibiotics of <span class="elsevierStyleItalic">Helicobacter pylori</span> &#40;<span class="elsevierStyleItalic">H&#46; pylori</span>&#41; is the main factor that affects current therapeutic treatments&#46; The main objective of this study is to describe the pattern of antibiotic resistances in children with an infection due to <span class="elsevierStyleItalic">H&#46; pylori</span>&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">An observational&#44; retrospective study was conducted from 2014 to 2019&#44; which included patients between 5 and 17 years old&#44; on whom a gastroscopy&#44; with a gastric biopsy culture positive for <span class="elsevierStyleItalic">H&#46; pylori</span>&#44; and an antibiotic sensitivity study was performed&#46; The antibiotic sensitivity studies were performed using an epsilometer &#40;E-test&#41;&#46; The cut-off points to define the resistances were those proposed by the European Committee on Antimicrobial Susceptibility Testing &#8212; EUCAST&#46; The eradication study was performed using the 13C-urea breath test or the <span class="elsevierStyleItalic">H&#46; pylori</span> monoclonal test in faeces 6&#8211;8 weeks after finalising the treatment&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The study included 80 patients &#40;63&#46;8&#37; females&#41;&#44; with a mean age of 11&#46;9 years &#40;SD&#8239;&#177;&#8239;2&#46;7 DS&#41;&#46; Over one-third &#40;38&#46;8&#37;&#41; of the patients had received previous treatment for <span class="elsevierStyleItalic">H&#46; pylori</span>&#46; In the endoscopy&#44; peptic ulcer lesions were observed in 10&#37; of patients&#46; More than two-thirds &#40;67&#46;5&#37;&#41; had resistance to at least one drug&#46; 16&#46;3&#37; presented double resistance&#46; The primary resistances were&#58; clarithromycin&#44; 44&#46;9&#37;&#44; metronidazole 16&#46;3&#37;&#44; levofloxacine 7&#46;9&#37;&#44; and amoxicillin 2&#37;&#46; Patients that received treatment according to the new ESPGHAN 2017 guidelines had significantly higher eradication rates compared to those that received treatment according to previous guidelines &#40;80&#37; vs&#46; 55&#46;8&#37;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;04&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The high rate of <span class="elsevierStyleItalic">H&#46; pylori</span> resistances&#44; and as a result&#44; the low eradication rates&#44; are still a very important cause for concern&#46; The first line treatment&#44; when this is indicated must be given following the antibiotic sensitivity studies&#44; and in the cases where these cannot be done or are not available&#44; at least in accordance with the regional resistance rates&#46; The correct application of the new guidelines significantly improves the eradication rate&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las resistencias antibi&#243;ticas de <span class="elsevierStyleItalic">Helicobacter pylori</span> &#40;<span class="elsevierStyleItalic">H&#46; pylori</span>&#41; son el principal factor que afecta a la eficacia de los reg&#237;menes terap&#233;uticos actuales&#46; El objetivo principal del estudio es describir el patr&#243;n de resistencias antibi&#243;ticas en ni&#732;nos con infecci&#243;n por <span class="elsevierStyleItalic">H&#46; pylori</span>&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo de 2014 a 2019 en el que se incluyen pacientes entre 5&#8211;17 a&#241;os a los que se realiz&#243; gastroscopia&#44; con cultivo de biopsia g&#225;stricapositivo para <span class="elsevierStyleItalic">H&#46; pylori</span> y estudio de sensibilidad a antibi&#243;ticos&#46; Los estudios de sensibilidad antibi&#243;tica se realizaron mediante E-test&#46; Los puntos de corte para definir las resistencias fueron los propuestos por el EUCAST&#46; El estudio de erradicaci&#243;n se realiz&#243; con test del aliento con urea marcada con C 13 o test monoclonal de ant&#237;geno de <span class="elsevierStyleItalic">H&#46; pylori</span> en heces a las 6&#8211;8 semanas de finalizar el tratamiento&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Ochenta pacientes &#40;63&#44;8&#37; mujeres&#41;&#46; Media de edad 11&#44;9 a&#241;os &#40;&#177;2&#44;7 DS&#41;&#46; Un 38&#44;8&#37; hab&#237;an recibido tratamiento previo para H&#46; pylori&#46; Un 10&#37; presentaron en la endoscopia lesiones ulcerosas p&#233;pticas&#46; El 67&#44;5&#37; presentaba resistencia al menos a un f&#225;rmaco&#46; Un 16&#44;3&#37; presentaron doble resistencia&#46; Las resistencias primarias fueron&#58; claritromicina 44&#44;9&#37;&#44; metronidazol 16&#44;3&#37;&#44; levofloxacino 7&#44;9&#37; y amoxicilina 2&#37;&#46; Los pacientes que recibieron tratamiento acorde a las nuevas gu&#237;as ESPGHAN 2017 presentaron tasas de erradicaci&#243;n significativamente superiores en comparaci&#243;n con los que recibieron tratamiento acorde a las gu&#237;as previas &#40;80&#37; vs&#46; 55&#44;8&#37; p&#8239;&#61;&#8239;0&#44;04&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La alta tasa de resistencias de <span class="elsevierStyleItalic">H&#46; pylori</span> y&#44; en consecuencia&#44; las bajas tasas de erradicaci&#243;n&#44; siguen siendo una preocupaci&#243;n muy importante&#46; El tratamiento de primera l&#237;nea&#44; cuando est&#233; indicado debe hacerse guiado por estudios de sensibilidad antibi&#243;tica y en los casos en el que no se puedan realizar o no est&#233;n disponibles&#44; al menos de acuerdo con las tasas regionales de resistencia&#46; La aplicaci&#243;n correcta de las nuevas gu&#237;as mejora de forma significativa el nivel de erradicaci&#243;n&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Botija G&#44; Garc&#237;a Rodr&#237;guez C&#44; Recio Linares A&#44; Campelo Guti&#233;rrez C&#44; P&#233;rez-Fern&#225;ndez E&#44; Barrio Merino A&#46; Resistencias antibi&#243;ticas y tasas de erradicaci&#243;n en infecci&#243;n por <span class="elsevierStyleItalic">Helicobacter pylori</span>&#46; An Pediatr &#40;Barc&#41;&#46; 2021&#59;95&#58;431&#8211;437&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Previous presentation&#58; preliminary results of the study were presented as a brief oral communication at the congresses of the Sociedad Espa&#241;ola de Gastroenterolog&#237;a&#44; Hepatolog&#237;a y Nutrici&#243;n Pedi&#225;trica &#40;SEGHNP&#41; held in Gijon&#44; Spain&#44; in 2016 and in Santander&#44; Spain&#44; in 2019&#46;</p>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;683&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;775&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Born in Spain</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Previous treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;0&#46;1-6&#93;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Clarithromycin</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;4&#8239;&#177;&#8239;2&#46;7</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;4&#8239;&#177;&#8239;2&#46;6</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;133&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Born in Spain</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Previous treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;0&#46;1-6&#93;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Metronidazole</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;2&#8239;&#177;&#8239;2&#46;5</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;3&#8239;&#177;&#8239;2&#46;9</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;188&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;975&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Born in Spain</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;755&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Previous treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Double resistance</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;9&#8239;&#177;&#8239;2&#46;6</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;9&#8239;&#177;&#8239;3&#46;1</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;969&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 23412879
Original language: English
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Idiomas
Anales de Pediatría (English Edition)
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?