A Pilot Study of Helicobacter pylori Eradication Using a Polymerase Chain Reaction-based Test for Clarithromycin Resistance

Empiric Versus Clarithromycin Resistance-Guided Therapy for Helicobacter pylori Based on Polymerase Chain Reaction Results in Patients With Gastric Neoplasms or Gastric Mucosa-Associated Lymphoid Tissue Lymphoma: A Randomized Controlled Trial

We investigated to compare the effect of empirical therapy vs clarithromycin resistance–guided tailored therapy (tailored therapy) for eradication of Helicobacter pylori.

Dual Clarithromycin and Metronidazole Resistance Is the Main Cause of Failure in Ultimate Helicobacter pylori Eradication

BACKGROUND/AIM

Antimicrobial resistance significantly affects the cure rate of Helicobacter pylori (H. pylori) eradication. We evaluated the risk factor of failure in ultimate H. pylori eradication and assessed the efficacy of current regimens to overcome antibiotic resistance.

METHODS

Patients with H. pylori infection were prospectively enrolled in a single center. They were classified into 3 groups according to the previous history of H. pylori eradication, and antibiotic susceptibility was evaluated by culture and minimum inhibitory concentrations (MICs).

RESULTS

Ninety-seven patients were successfully cultured for H. pylori and 81 (83.5%), 7 (7.2%), and 9 (9.3%) were classified into primary resistance, 1st eradication failure, and 2nd or more eradication failure groups; the resistance to clarithromycin (CLA), metronidazole (MET), and levofloxacin increased in the 1st eradication failure (85.7, 57.1, and 42.9%) and 2nd or more eradication failure (88.9, 88.9, and 55.6%) groups. The prevalence of MDR was 21.0% (17/81), 57.1% (4/7), and 88.9% (8/9) in the primary, 1st eradication failure, and 2nd or more eradication failure groups, respectively. In multivariate analysis, dual CLA/MET resistance (CLA/MET-R) (OR = 31.432, 95% CI: 3.094-319.266, p = 0.004) was an independent risk factor for ultimate H. pylori eradication failure. In patients with dual CLA/MET-R, the eradication ratio of concomitant therapy was 57.1% (4/7), whereas that of bismuth-containing quadruple therapy was 27.3% (3/11) (p = 0.350).

CONCLUSIONS

Dual CLA/MET-R was the main cause of failure in ultimate H. pylori eradication, and 7-day bismuth quadruple or concomitant regimen would not be suitable for H. pylori eradication in the dual CLA/MET-R group.

Efficacy of tailored therapy for Helicobacter pylori eradication based on clarithromycin resistance and survey of previous antibiotic exposure: A single-center prospective pilot study

BACKGROUND

As the prevalence of antibiotic resistance is increasing, the effectiveness of traditional Helicobacter pylori (H pylori) therapies is gradually declining. We aimed to evaluate the efficacy of tailored therapy (dual priming oligonucleotide [DPO]-based multiplex PCR) and previous antibiotic exposure survey predicting for antibiotic resistance.

MATERIALS AND METHODS

Patients with H pylori infection who did not receive previous treatment were enrolled. The patients were divided into four groups (no resistance [NR] group, clarithromycin resistance [CLA-R] group, metronidazole-resistant [MET-R] group, and CLA- and MET-resistant [Dual-R] group) based on the results of dual priming oligonucleotide (DPO) polymerase chain reaction (PCR) and previous antibiotic exposure survey, and they were treated with tailored therapy based on antibiotic susceptibility.

RESULTS

Consecutive patients were distributed in the NR (n = 36, 70.6%), CLA-R (n = 9, 17.6%), and suspected MET-R (n = 6, 11.8%) group. The overall intention-to-treat/per-protocol eradication rate (ITT/PP) was 92.2%/94.0%. In the subgroup analysis, the ITT and PP of the NR, CLA-R, and MET-R groups were 94.4%/94.4%, 77.8%/87.5%, and 100.0%/100.0%, respectively. Total of 31 patients in all subgroups were evaluated for antibiotic resistance; five (16.1%), two (6.5%), and three (9.7%) participants showed CLA, MET, and dual resistance in culture-based susceptibility test. Compared with culture-based MIC test, the accuracy of DPO-based multiplex PCR in determining CLA resistance was 90.3%, while the accuracy of survey in determining MET resistance was only 77.4%.

CONCLUSION

A tailored therapy based on DPO-PCR and history of previous antibiotic use is useful in clinical practice and well correlated with culture-based susceptibility test.