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

Abstract

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.

Review – Treatment of Helicobacter pylori infection 2020

“…In Korea, a study used personalised treatment, after testing with dual priming oligonucleotide (DPO) polymerase chain reaction (PCR) and asking for a previous antibiotic exposure in order to predict resistance. The tailored first‐line treatment based on antibiotic susceptibility, reported an eradication rate of 92% 51 . Another first‐line study also conducted in Korea involved administration of either a 7‐day clarithromycin‐containing TT, a 7‐day moxifloxacin‐containing TT, or a 7‐ or 14‐day bismuth quadruple therapy (BQT) based on the MIC of the various antibiotics and reported 93% eradication with common adverse events such as epigastric pain, nausea, and vomiting occurring less commonly than with empirical therapies 52 .…”

“…An unprecedented number of studies last year reported on the important topic of antimicrobial resistance of H pylori strains 24‐60 . These are outlined in Table 1.…”

Efficacy of bismuth‐based quadruple therapy for eradication of Helicobacter pylori infection based on previous antibiotic exposure: A large‐scale prospective, single‐center clinical trial in China

“…Valle‐Muñoz et al reported that a bismuth quadruple therapy consisting of omeprazole and a three‐in‐one capsule containing omeprazole, bismuth subcitrate, metronidazole, and tetracycline for 10 days achieved eradication rates of 85.9% and 98.5% in 78 Spanish patients with previous use of macrolides, as calculated through intention‐to‐treat (ITT) and per‐protocol (PP) analyses 32 . Kwon et al demonstrated eradication rates of 92.2% (ITT) and 94.0% (PP) in 51 Korean patients using 14‐day triple therapies tailored for resistance to clarithromycin and metronidazole based on antibiotic susceptibility testing and previous antibiotic exposure 33 . However, these studies were limited to targeting a single or dual antibiotics, and the small number of patients, and the exclusion of patients with a previously failed eradication therapy 32,33 .…”

“…Kwon et al demonstrated eradication rates of 92.2% (ITT) and 94.0% (PP) in 51 Korean patients using 14‐day triple therapies tailored for resistance to clarithromycin and metronidazole based on antibiotic susceptibility testing and previous antibiotic exposure 33 . However, these studies were limited to targeting a single or dual antibiotics, and the small number of patients, and the exclusion of patients with a previously failed eradication therapy 32,33 . In a preliminary study of 327 Chinese patients, eradication rates of 63.5%, 76.2%, and 82.6% (ITT) and 76.7%, 92.4%, and 96.4%(PP), respectively, were observed with bismuth‐based quadruple therapies with amoxicillin‐free, nitroimidazole‐free, and amoxicillin‐nitroimidazole‐clarithromycin‐free regimens 34 .…”

Efficacy of tailored second-line therapy of Helicobacter pylori eradication in patients with clarithromycin-based treatment failure: a multicenter prospective study

“…In regions with a high clarithromycin resistance rate (26.12%), the administration of tailored colloidal bismuth pectin-containing quadruple therapy to patients for 14 days has achieved eradication rates of 85.99% and 91.22% according to intention-to-treat (ITT) and per protocol (PP) analyses, respectively [ 12 ]. The eradication rates of susceptibility-guided therapies have been reported to exceed 90%, according to PP analyses, in regions with high clarithromycin resistance rates (> 15%), even when these therapies were used as rescue treatments [ 2 , 11 – 14 ].…”