Efficacy of 7-day Tailored Therapy for <i>Helicobacter pylori</i> Eradication based on Clarithromycin Resistance

Bae, June Hwa; Jo, Hyeong Ho; Kwon, Joong Goo; Kim, Eun Young

doi:10.4166/kjg.2023.039

Cited by 3 publications

(1 citation statement)

References 34 publications

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“…Studies have reported better eradication success rates using tailored therapy than empiric therapy, especially when antimicrobial susceptibility testing was performed before treatment. 148 149 150 151 However, the benefit of tailored therapy has not been demonstrated in clinical trials comparing tailored therapy with empirical quadruple regimens as a first-line treatment or tailored therapy after previous treatment failure. 151 152 153 This suggests that the benefit of tailored therapy is not obvious when the empirical regimen is highly effective for H. pylori eradication.…”

Section: Cilnical Implication and Future Directionsmentioning

confidence: 99%

Antibiotic Resistance of Helicobacter pylori: Mechanisms and Clinical Implications

Hasanuzzaman,

Bang,

Gong

2024

J Korean Med Sci

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Helicobacter pylori is a pathogenic bacterium associated with various gastrointestinal diseases, including chronic gastritis, peptic ulcers, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. The increasing rates of H. pylori antibiotic resistance and the emergence of multidrug-resistant strains pose significant challenges to its treatment. This comprehensive review explores the mechanisms underlying the resistance of H. pylori to commonly used antibiotics and the clinical implications of antibiotic resistance. Additionally, potential strategies for overcoming antibiotic resistance are discussed. These approaches aim to improve the treatment outcomes of H. pylori infections while minimizing the development of antibiotic resistance. The continuous evolution of treatment perspectives and ongoing research in this field are crucial for effectively combating this challenging infection.

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Section: Cilnical Implication and Future Directionsmentioning

confidence: 99%

Antibiotic Resistance of Helicobacter pylori: Mechanisms and Clinical Implications

Hasanuzzaman,

Bang,

Gong

2024

J Korean Med Sci

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Comparison of Helicobacter pylori eradication rates between 7 and 14 days of tailored therapy according to clarithromycin resistance test: A randomized, multicenter, non‐inferiority study

Jung,

Jee,

Lee

et al. 2024

Helicobacter

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BackgroundRecently, a simple tailored therapy based on clarithromycin resistance has been implemented as Helicobacter pylori (H. pylori) eradication therapy. Nonetheless, despite the tailored therapy and frequent adverse events, studies on treatment period are lacking. This study aimed to compare the H. pylori eradication rates of 7‐day and 14‐day tailored therapy regimens according to clarithromycin resistance.Materials and MethodsThis multicenter, prospective, randomized, noninferiority trial enrolled H. pylori‐positive patients who were randomly assigned to 7‐day and 14‐day regimen groups, depending on the presence or absence of clarithromycin resistance by 23S rRNA gene point mutations. Standard triple therapy (STT) (20 mg rabeprazole, 1 g amoxicillin, and 500 mg clarithromycin twice daily) or bismuth quadruple therapy (BQT) (20 mg rabeprazole twice daily, 500 mg metronidazole thrice daily, 120 mg bismuth four times daily, and 500 mg tetracycline four times daily) was assigned by clarithromycin resistance. Eradication rates and adverse events were evaluated.ResultsA total of 314 and 278 patients were included in the intention‐to‐treat (ITT) and per‐protocol (PP) analyses, respectively; however, 31 patients were lost to follow‐up, whereas five patients violated the protocol. Both the 7‐day and 14‐day regimens showed similar eradication rates in the ITT (7‐day vs. 14‐day: 78.3% vs. 78.3%, p > 0.99) and PP (87.9% vs. 89.1%, p = 0.851) analyses. Non‐inferiority was confirmed (p < 0.025). A subgroup analysis according to clarithromycin resistance (clarithromycin resistance rate: 28.7%) revealed no significant difference in eradication rates between the 7‐day and 14‐day STT (90.0% vs. 90.1%, p > 0.99) and BQT (82.5% vs. 86.5%, p = 0.757). Furthermore, adverse events did not significantly differ between the two groups.ConclusionsThe 7‐day triple and quadruple therapy according to clarithromycin resistance showed similar eradication rates, as compared to the 14‐day therapy.

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Empirical Therapy Versus Tailored Therapy of Helicobacter pylori in Korea: Results of the K‐CREATE Study

Kim,

Kim

et al. 2024

Helicobacter

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BackgroundThe optimal duration of regimens for tailored therapy based on genotypic resistance for clarithromycin has yet to be established.AimThis study was a nationwide, multicenter, randomized trial comparing empirical therapy with tailored therapy based on genotypic resistance for first‐line eradication of Helicobacter pylori. We also compared the eradication rates of 7‐ and 14‐day regimens for each group.Patients and MethodsPatients with H. pylori infection were first randomized to receive empirical or tailored therapy. Patients in each group were further randomized into 7‐ or 14‐day regimens. Empirical therapy consisted of a triple therapy (TT) regimen (twice‐daily doses of pantoprazole 40 mg, amoxicillin 1 g, and clarithromycin 500 mg) for 7 or 14 days. Tailored therapy consisted of TT of 7 or 14 days in patients without genotypic resistance. Patients with genotypic resistance were treated with bismuth quadruple therapy (BQT) regimens (twice‐daily doses of pantoprazole 40 mg, three daily doses of metronidazole 500 mg, and four times daily doses of bismuth 300 mg and tetracycline 500 mg) for 7 or 14 days. A 13C‐urea breath test assessed eradication rates. The primary outcome was eradication rates of each group.ResultsA total of 593 patients were included in the study. The eradication rates were 65.7% (201/306) in the empirical therapy group and 81.9% (235/287) in the tailored therapy group for intention‐to‐treat analysis (p < 0.001). In the per‐protocol analysis, the eradication rates of the empirical therapy and tailored groups were 70.3% (201/286) and 85.5% (235/274) (p < 0.001), respectively. There was no difference in compliance between the two groups. The rate of adverse events was higher in the tailored group compared to the empirical group (p < 0.001).DiscussionOur study confirmed that tailored therapy based on genotypic resistance was more effective than empirical therapy for H. pylori eradication in Korea. However, no significant difference was found between 7‐ and 14‐day regimens for each group. Future studies are needed to determine the optimal duration of therapy for empirical and tailored therapy regimens.

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Efficacy of 7-day Tailored Therapy for Helicobacter pylori Eradication based on Clarithromycin Resistance

Cited by 3 publications

References 34 publications

Antibiotic Resistance of Helicobacter pylori: Mechanisms and Clinical Implications

Antibiotic Resistance of Helicobacter pylori: Mechanisms and Clinical Implications

Comparison of Helicobacter pylori eradication rates between 7 and 14 days of tailored therapy according to clarithromycin resistance test: A randomized, multicenter, non‐inferiority study

Empirical Therapy Versus Tailored Therapy of Helicobacter pylori in Korea: Results of the K‐CREATE Study

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