Helicobacter pylori eradication therapy outcome according to clarithromycin susceptibility testing in Japan

Abstract

BackgroundHelicobacter pylori (Hp) infection increases the risk of gastric cancer. Therefore, eradication is a global goal, which requires continuous monitoring of therapeutic regimens and effectiveness. Clarithromycin resistance is an important contributor to eradication failure, and metronidazole is recommended as second‐line treatment in such cases. Here, we retrospectively evaluated the clarithromycin and metronidazole resistance rates and treatment effectiveness in patients with Hp using tailored therapies according to clarithromycin susceptibility testing.MethodsData on drug susceptibility were obtained for 5249 Japanese Hp patients between July 2005 and August 2018. Clarithromycin/metronidazole resistance rates were analyzed according to year, gender, and age with Fisher's exact test. The relationship between clarithromycin resistance and Hp therapy outcomes was assessed for 1300 patients. Treatment regimens included a clarithromycin‐ or metronidazole‐containing 7‐day triple therapy with one of several proton pump inhibitors and vonoprazan.ResultsClarithromycin resistance increased annually and was higher in women and younger patients (<30 years). Rates of metronidazole resistance were stable but decreased with age. Hp treatment regimens using PPIs had eradication rates of 88% and 45% among clarithromycin‐sensitive and clarithromycin‐resistant cases, respectively, while regimens including vonoprazan had eradication rates of around 90% regardless of clarithromycin susceptibility. In particular, triple therapy with vonoprazan, amoxicillin, and metronidazole achieved 98% eradication.ConclusionClarithromycin‐containing triple therapy even using vonoprazan did not achieve satisfactory eradication rates even in the clarithromycin‐sensitive group. To avoid antibiotic misuse in population with low metronidazole resistance, 7‐day vonoprazan, amoxicillin, and metronidazole triple therapy might be a strong candidate as a first‐line eradication therapy.

Designing strategies for eradication of Helicobacter pylori based on prevalence patterns of infection and antibiotic resistance in a low‐income, medically underserved community in the United States

“…Female sex was one of the indications for H pylori infection prevalence in our population. A recent study from Japan showed that clarithromycin resistance was higher in females 16 . Two ethnicities, African American and Hispanic, were predominant in our patient population.…”

“…These were based on respective percentages seen for each of these factors within our H pylori patients as well as those reported in the literature. For example, it has been reported that females and African American and Hispanic races have a higher probability of getting H pylori infection 16,17 . The lower panel indicates major factors that influence the eradication of H pylori ; filled circles indicate factors reducing eradication.…”

Dietary intake of walnut prevented <i>Helicobacter pylori</i>-associated gastric cancer through rejuvenation of chronic atrophic gastritis

“…In clinic, the importance of either H. pylori eradication or their regulation impose significant impact on either gastric cancer prevention or gastric diseases amelioration, for which several kinds of intervention like natural products, probiotics, and more effective anti-H. pylori therapy are under active investigation. (68)(69)(70)(71) In conclusion, walnut seems to be very effective and attractive because of well-acknowledgement as "pharmanutrient" against H. pylori infection. However, welldesigned clinical trial should be followed.…”

Association Between Patients’ Immunoglobulin E Levels and Difficulty Eradicating Helicobacter pylori

“…However, because susceptibility to clarithromycin was not considered, we further analyzed the results by taking susceptibility into account, given that many Japanese are resistant to clarithromycin. 21 As shown in Table 3, we used multinomial logistic regression because the dependent variable was divided into three levels: one, two, and three or more eradication attempts. Model 1 is the crude model.…”