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With these second treatments, eradication was achieved in 24 of the 30 (80%) cases; with treatment success in 14 of the 19 (73.6%) patients treated with OAL. Some adverse effects were observed in 31 (14%) of the 221 total patients treated with 10-day OAC (11 cases of altered taste, eight of diarrhoea, six of stomach ache, four of headache and two of oral candidiasis), nonetheless all patients completed the full treatment. The average cost of the eradication with 10-day OAC was ��571.20 per patient when diagnosis was made by culture with antimicrobial susceptibility, and ��666.80 in the UBT group, where patients were empirically treated. Overall, in 2008, H.?pylori resistance Ixazomib rates were 37.2% for metronidazole (MIC >4?mg/L), 21.1% for clarithromycin (MIC >1?mg/L according to the recommendation of the CLSI [6]) and 15.1% for levofloxacin (MIC >2?mg/L). No resistance was detected to tetracycline (MIC?>4?mg/L) or amoxicillin (MIC?selleck chemicals was 10.7% (rising year on year: 5.6% in 1994, 7% in 1995, 8.5% in 1996, 12.9% in 1997 and 19.5% in 1998) [7]. In the 5-year period 2006�C10, in a total of 2617 H.?pylori isolates the primary resistance to clarithromycin reached 18% (15.7% in 2006, 17.8% in 2007, 21.1% in 2008, 17.6% in 2009 and 18.1% in 2010; Table?2). In Europe, primary resistance to this antibiotic in adults has a north/south gradient, with Thalidomide prevalence being lower in northern European countries (2�C11%) and higher in the south (12�C22%) [8,9]. Across Europe [9], around 10% of the H.?pylori isolates are resistant to more than one family of antibiotics. In our region, multi-resistance was detected in 10.5% of the H.?pylori isolates in the period 1994�C98 and in 14.9% in 2008. Double resistance to clarithromycin and metronidazole was 8.9% in the present study, higher than the figure cited in a recent literature review [9], where the highest rate was that for Japan (6.6%). This situation makes it even more difficult for H.?pylori eradication treatments to be successful and increases the need to search for other therapeutic strategies. In two European multicentre trials [10,11] (MACH1 and MACH2), reported in 1996 and 1999, the efficacy of the 7-day OAC and OMC triple therapies for the eradication of H.?pylori was confirmed. Notably, in the MACH2 study the rate of resistance to clarithromycin was just 3%.