Marco Manfredi, MD, pediatrician and gastroenterologist, carried out his education at Parma University where completed his PhD in Pediatric Gastroenterology in 2004. Currently he is working as Manager of Pediatric Emergency and Assistant Manager in Pediatric Gastroenterology at “Pietro Barilla” Children\'s Hospital in Parma, Italy. His main fields of interests are Helicobacter pylori infection, coeliac disease, gastrointestinal infectious diseases, and IBS. He has published more than 60 papers and has included chapters of textbooks. He is editor of two textbooks on “Helicobacter pylori infection” and on “Gastrointestinal Endoscopy in Children” published by Nova Science Publishers, New York, USA. He is serving as an editorial board member of several reputed journal like “Clinical Microbiology: open access” and “Frontiers in Pediatric Gastroenterology and Hepatology” and expert Reviewer for journals like BMC Gastroenterology, Saudi Journal of Gastroenterology, BMC Case Reports. He is a member of Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition.


The eradication therapy of Helicobacter pylori infection is still a challenge for gastroenterologists. One of the main causes of failure in H. pylori eradication is the antibiotic resistance mainly to clarithromycin. The culture from biopsies maybe the most used method among the antimicrobial susceptibility testing, but despite of its high costs it has a variable success rate of development. Although the main international guidelines still recommend the triple therapy as first-line therapy in eradication of H. pylori infection, this therapeutic regimen is decreasing of efficacy all over the world. We compared the antimicrobial susceptibilities in children with H. pylori infection over 13 years and we confirmed that the clarithromycin resistance is strongly increasing, as noted by many authors in the world. Therefore the clarithromycin should not be used as empiric treatment of H. pylori infection, but its use should be limited only to those patients with known antimicrobial susceptibility. If we don\'t know the antibiotic susceptibility of patients, we should recommend an eradication therapy based on the local distribution of antibiotic resistance rates thus trying to limit the therapeutic failures. Many studies confirmed that sequential therapy achieves a good effectiveness even in patients with clarithromycin and metronidazole resistance, therefore if we don\'t know neither the antimicrobial susceptibility nor the local distribution of antibiotic resistance, in our opinion, sequential therapy could provide the best eradication rate as empiric treatment.

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