Tailored susceptibility-guided therapy via gastric juice PCR for the first-line H. pylori eradication, a randomized controlled trial

Hsieh, Meng-Long; Kuo, Fu‐Chen; Wu, Meng‐Chieh; Wang, Jiunn-Wei; Liu, Chung‐Jung; Chu, Neng-Sheng; Tsai, Pei-Yi; Hsu, Ping‐I; Wu, I-Chen; Wu, Jeng‐Yih; Wu, Deng‐Chyang; Yu, Fang‐Jung; Kuo, Chao‐Hung

doi:10.1016/j.jfma.2021.10.011

Cited by 9 publications

(14 citation statements)

References 28 publications

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“…A flow chart explaining the study selection is shown in Figure 1. Of the 2156 titles initially found by the literature searches, 34 studies were found suitable for meta‐analysis 28–61 . Two studies 50,61 had 3 arms comparing the tailored treatment regimen with two different empiric regimens.…”

Section: Resultsmentioning

confidence: 99%

“…There were 25 randomized control trials (RCTs) 28,29,31,35,37,38,40–45,49–57,59,61 and 9 non‐randomized trials (NRT) 30,32–34,36,39,46,58,60 . Thirty‐two of the enrolled studies 29–57,59–61 contained adult population, and 2 studies 28,58 contained children. All 34 studies contained a total of 9613 patients allocated to tailored regimens (4875 patients) and to empirical regimens (4738 patients).…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, these two studies contained 2 sets of data each, making the total number of pair comparisons in the meta-analysis 36. There were 25 randomized control trials (RCTs) 28,29,31,35,37,38,[40][41][42][43][44][45][49][50][51][52][53][54][55][56][57]59,61 and 9 non-randomized trials (NRT). 30,[32][33][34]36,39,46,58,60 Thirty-two of the enrolled studies [59][60][61] contained adult population, and 2 studies 28,58 contained children.…”

Section: Sensitivity Analyses and Publication Biasmentioning

confidence: 99%

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Current role of tailored therapy in treating Helicobacter pylori infections. A systematic review, meta‐analysis and critical analysis

2022

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Background and Aims Recent guidelines dictate that all Helicobacter pylori (H. pylori) infected subjects should receive curative therapy. The efficacy of empirical regimens for H. pylori eradication might decline with bacterial, drug, and host factors. The necessity of a tailored therapy still remains controversial. Here we provide a meta‐analysis of the current status of susceptibility‐based (tailored) therapy in which susceptibility‐based therapies were compared to the currently accepted choice of empiric therapy. In this rapidly closing era, neither the susceptibility nor empiric therapies were routinely optimized, such that we report the outcome of comparisons on the efficacy of unoptimized tailored vs. locally preferred empiric treatments. Methods PubMed, Medline, and Embase databases were searched using suitable keywords. Individual and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the fixed‐ or random‐effects model as appropriate. Heterogeneity was calculated employing the Cochrane Q test and I2 values, whereas the possibility of publication bias was examined by constructing funnel plots. Additionally, subgroup and sensitivity analyses were performed. Results Thirty‐four studies were included with a total of 9613 patients. Tailored therapy proved superior to empiric treatment [OR 2.07 (95% CI 1.53–2.79)]. However, tailored therapy achieved eradication rates >90% in only 15 (44%) studies and >95% in only 6 (17.6%). Conclusions Although tailored therapy performed better than empiric treatment, the lack of optimization of therapies failed to reliably achieve high cure rates (>90%). These results emphasize that H. pylori infection, like other infectious diseases, should utilize the principles of antimicrobial stewardship in relation to treatment guidance.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Sensitivity Analyses and Publication Biasmentioning

confidence: 99%

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Current role of tailored therapy in treating Helicobacter pylori infections. A systematic review, meta‐analysis and critical analysis

2022

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“…“However, due to the global increasing primary resistance rate for clarithromycin, metronidazole, and levofloxacin, to achieve a higher eradication rate of ILTHPI, selection of optimal antibiotics in accordance with the geographical surveillance of antibiotic resistances or based on pre-ILTHPI molecular stool AST [ 28 , 29 , 30 ] is extremely important”. Meanwhile, the gastric juice obtained during the ILTHPI could also provide susceptibility-guided therapy for patients who failed ILTHPI [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Intraluminal Therapy for Helicobacter pylori Infection—Comparison of Medicament Containing Tetracycline, Metronidazole, and Bismuth versus Amoxicillin, Metronidazole, and Clarithromycin: A Randomized Controlled Study

Liu

Chen

et al. 2023

Biomedicines

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Helicobacter pylori (H. pylori) can be eradicated immediately via local application of single-dose medicament on endoscopic examination. In our previous report, “the eradication rate of intraluminal therapy for H. pylori infection (ILTHPI) is 53.7% (51/95) using medicament containing amoxicillin, metronidazole, and clarithromycin”. We aimed to evaluate the efficacy and adverse events of medicament containing tetracycline, metronidazole, and bismuth and to improve the efficacy of stomach acid control before ILTHPI. After usage of dexlansoprazole (60 mg b.i.d.) or vonoprazan (20 mg q.d.) for 3 days before ILTHPI, 103 of 104 (99.1%) symptomatic H. pylori-infected treatment-naïve patients achieved levels of stomach pH ≥ 6. Patients were randomized to receive ILTHPI with medicaments containing tetracycline, metronidazole, and bismuth (Group A, n = 52) or amoxicillin, metronidazole, and clarithromycin (Group B, n = 52). The eradication rate of ILTHPI was similar between Group A (76.5%; 39/51) and Group B (84.6%, 44/52) (p = 0.427) and the adverse event was mild diarrhea (2.9%; 3/104). The eradication rate significantly increased from 53.7% (51/95) to 84.6% (44/52) after acid control (p = 0.0004) for Group B patients. The overall eradication rates of successful ILTHPI plus 7-day non-bismuth (Group A) or 7-day bismuth (Group B) oral quadruple therapy for ILTHPI failure patients were both excellent (96.1% for Group A and 98.1% for Group B).

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“…Based on the results of AST, the possibility of clinically applying tailored therapy with individually-selected susceptible antimicrobial agents is being explored. 93 Several RCTs showed the superiority of tailored therapy over STT, when comparing the efficacy of tailored therapy and empirical therapy in detecting clarithromycin-resistant strains using molecular-based methods 73,[94][95][96][97] as well as using culture-based methods (Table 4). [98][99][100][101][102][103] However, RCTs that compared the efficacy of tailored therapy and empirical therapy using BQT, quadruple concomitant, or fluoroquinolone-containing regimens failed to show the superiority of tailored therapy (Table 4).…”

Section: Clinical Outcomes Of Tailored Therapymentioning

confidence: 99%

Optimizing Helicobacter pylori Treatment: An Updated Review of Empirical and Susceptibility Test-Based Treatments

et al. 2023

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As the rate of discovery of drug-resistant Helicobacter pylori cases increases worldwide, the relevant societies have updated their guidelines for primary eradication regimens. A promising strategy against drug-resistant H. pylori is tailored therapy based on the results of an antibiotic susceptibility test; however, it is difficult to apply this strategy to all cases. Although culture-based antibiotic susceptibility tests can assess resistance to any antimicrobial agent, their greatest disadvantage is the time required to draw a conclusion. In contrast, molecular-based methods, such as polymerase chain reaction, can rapidly determine the presence of resistance, although a single test can only test for one type of antimicrobial agent. Additionally, the limited availability of facilities for molecular-based methods has hindered their widespread use. Therefore, low-cost, minimally invasive, simple, and effective primary regimens are needed. Several studies have compared the efficacy of the latest primary eradication regimens against that of tailored therapies, and their results have shaped guidelines. This article reviews the latest research on empirical and tailored treatments for H. pylori infections. Evidence for the superiority of tailored therapy over empirical therapy is still limited and varies by region and treatment regimen. A network meta-analysis comparing different empirical treatment regimens showed that vonoprazan triple therapy provides a superior eradication effect. Recently, favorable results towards vonoprazan dual therapy have been reported, as it reached eradication levels similar to those of vonoprazan triple therapy. Both vonoprazan dual therapy and tailored therapy based on antibiotic susceptibility tests could contribute to future treatment strategies.

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Tailored susceptibility-guided therapy via gastric juice PCR for the first-line H. pylori eradication, a randomized controlled trial

Cited by 9 publications

References 28 publications

Current role of tailored therapy in treating Helicobacter pylori infections. A systematic review, meta‐analysis and critical analysis

Current role of tailored therapy in treating Helicobacter pylori infections. A systematic review, meta‐analysis and critical analysis

Intraluminal Therapy for Helicobacter pylori Infection—Comparison of Medicament Containing Tetracycline, Metronidazole, and Bismuth versus Amoxicillin, Metronidazole, and Clarithromycin: A Randomized Controlled Study

Optimizing Helicobacter pylori Treatment: An Updated Review of Empirical and Susceptibility Test-Based Treatments

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