Rational Helicobacter pylori Therapy: Evidence-Based Medicine Rather Than Medicine- Based Evidence  David Y. Graham, Yi–Chia Lee, Ming–Shiang Wu  Clinical Gastroenterology and Hepatology  Volume 12, Issue 2, Pages 177-186.e3 (February 2014) DOI: 10.1016/j.cgh.2013.05.028 Copyright © 2014 Terms and Conditions

Figure 1 Recommended approach to treatment of H pylori infections. Rx, treatment. Clinical Gastroenterology and Hepatology 2014 12, 177-186.e3DOI: (10.1016/j.cgh.2013.05.028) Copyright © 2014 Terms and Conditions

Figure 2 Example of choices of clarithromycin-containing regimens for an individual patient based on predicted resistance to clarithomycin and metronidazole. Clinical Gastroenterology and Hepatology 2014 12, 177-186.e3DOI: (10.1016/j.cgh.2013.05.028) Copyright © 2014 Terms and Conditions

Supplementary Figure 1 The effect of increasing metronidazole and clarithromycin resistance and the prevalence of dual clarithromycin-metronidazole resistance. When dual resistance equals 15% (dotted line), then 14-day concomitant therapy will cure less than 90% of patients. The proportion of patients with dual resistance is shown at different prevalences of metronidazole resistance, with the proportion with dual resistance plotted against the prevalence of clarithromycin resistance. As long as metronidazole resistance levels are less than 40%, the regimen is very resistant to typical increases in clarithromycin resistance. However, at high levels of resistance of either, only modest levels of resistance of the other will result in dual resistance exceeding the threshold level for treatment failure. Clinical Gastroenterology and Hepatology 2014 12, 177-186.e3DOI: (10.1016/j.cgh.2013.05.028) Copyright © 2014 Terms and Conditions