Aims We aimed to assess the eradication efficacy and factors that influencing it of high‐dose dual therapy (HDDT) in Gansu region, Northwest China. Methods A total of 216 treatment‐naive patients with Helicobacter pylori infection were randomly assigned to two groups for the 14‐day eradication treatment: the HDDT group (amoxicillin 750 mg q.i.d. and esomeprazole 40 mg t.i.d.) and the amoxicillin and clarithromycin‐containing bismuth quadruple therapy group (ACBQT: esomeprazole 20 mg, bismuth potassium citrate 2 g, amoxicillin 1 g, and clarithromycin 500 mg; b.i.d.). The eradication rates, adverse effects and patient compliance of these two groups were compared. Eradication efficacy was determined by 13C urea breath test (13C UBT) 4–8 weeks after finishing treatment. Antibiotic resistance was determined by the Epsilometer testing (E‐test) method. Results The eradication rates for the HDDT and ACBQT groups were 71.0% and 74.7% (P = .552) by per‐protocol analysis, and 65.7% and 68.5% (P = .664) by intention‐to‐treat analysis. The overall adverse event rates in the HDDT and ACBQT groups were 2.0% and 43.4% (P < .001), respectively. The resistance rates to amoxicillin, clarithromycin, tetracycline, levofloxacin and metronidazole were 15.2%, 42.0%, 5.4%, 35.7% and 83.0%, respectively. Amoxicillin resistance and delta over baseline (DOB) of 13C UBT ≥ 20 before treatment significantly reduced the eradication rate in 112 participants with H. pylori cultured. Conclusion The HDDT as first‐line treatment for H. pylori was unsatisfactory in Gansu. Amoxicillin resistance and DOB of 13C UBT ≥ 20 before treatment were significantly correlated with H. pylori eradication failure.

Contributions: (I) Conception and design: Y Lin, D Zhang; (II) Administrative support: D Zhang; (III) Provision of study materials or patients: Y Lin,

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Purpose This study aims to estimate the resistance rate of Helicobacter pylori ( HP ) to commonly used antibiotics and analyze the potential influencing factors in northwest regions of China. Patients and Methods HP -positive patients visiting the outpatient department of multiple hospitals were enrolled in the study. Then, gastric mucosal biopsy specimens were collected for HP isolation, culture, and investigation of the resistance rate of HP to amoxicillin, metronidazole, tetracycline, levofloxacin, and clarithromycin by Epsilometer test (E-test) antibiotic susceptibility testing. In addition, multi-drug resistance, the influence of HP eradication history, age, and region of residence on drug resistance rate were analyzed. Results In total, 198 HP clinical strains were successfully isolated and cultured. The resistance rates of amoxicillin, metronidazole, tetracycline, levofloxacin, and clarithromycin were 16.16%, 85.86%, 7.58%, 46.46%, and 55.05%, respectively. The multi-drug resistance rates demonstrated that dual and triple resistances were 30.30% and 22.73%, respectively. The quadruple resistance rate reached 9.60%. Our results revealed that the prior eradication history of HP significantly increased levofloxacin and clarithromycin resistance. Metronidazole and levofloxacin resistances significantly differed among different age groups, which presented an upward trend with increasing age. Drug resistance rates varied with geographic regions, especially amoxicillin and clarithromycin resistance, which were highest in Hexi Corridor and Longnan regions. Conclusion The current situation of HP resistance to common antibiotics is severe. Tetracycline is the most sensitive antibiotic, followed by amoxicillin, the first choice for HP eradication. However, the eradication failure of HP may lead to an increase in the resistance rate. Therefore, it is necessary to strengthen the standardized diagnosis and treatment of HP to improve the primary eradication rate.

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