A Pilot Study ofHelicobacter pyloriEradication Using a Polymerase Chain Reaction-based Test for Clarithromycin Resistance

Jung, Yun Hwa; Kim, Yeon Ji; Chung, Woo Chul

doi:10.7704/kjhugr.2017.17.4.200

Cited by 4 publications

(9 citation statements)

References 41 publications

(40 reference statements)

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“…However, there remained some limitations on PCR‐based tailored therapy as a primary H pylori eradication therapy. Although the tailored therapy showed an excellent eradication rate, the group with CLA‐R or Dual‐R strains showed relatively low eradication rates (70%‐80%), whereas those with CLA‐S strains showed higher eradication rates (>90%), as reported in previous studies . Our results also showed that the CLA‐R group had low eradication ratio (ITT/PP 77.8%/87.5%) compared with the NR group (ITT, 94.0% and PP, 94.0%).…”

Section: Discussionsupporting

confidence: 82%

“…which was consistent with those reported in previous studies and meta-analysis. 9,10,15,20,21 Currently, the most widely used empirical H pylori eradication therapy is the CLA-based standard triple therapy, which includes the use of two antibiotics (amoxicillin and clarithromycin) together with PPI. 2 However, the existing standard triple therapy reported unsatisfactory eradication success rate, which was influenced by several factors such as antibiotic susceptibility, insufficient inhibition of acid, bacterial genotypes that reduce virulence, and compliance.…”

Section: Culture and Mic Resultsmentioning

confidence: 99%

“…DPO‐PCR can detect A2142G and A2143G mutations of 23S rRNA genes associated with the resistance of H pylori to clarithromycin . Two specimens of gastric tissues (antrum and body) were obtained for RUT and DPO‐PCR …”

Section: Methodsmentioning

confidence: 99%

“…Recently, CLA resistance testing using dual priming oligonucleotide‐based multiplex polymerase chain reaction (DPO‐PCR) has been introduced. DPO‐PCR can detect H pylori itself and mutation of 23S rRNA, which is essential for CLA resistance . It is convenient to use, and the results are obtained within a short period.…”

Section: Introductionmentioning

confidence: 99%

“…DPO-PCR can detect H pylori itself and mutation of 23S rRNA, which is essential for CLA resistance. 10,11 It is convenient to use, and the results are obtained within a short period. This method enables tailored eradication.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionsupporting

confidence: 82%

Section: Culture and Mic Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Dual Clarithromycin and Metronidazole Resistance Is the Main Cause of Failure in Ultimate Helicobacter pylori Eradication

Hwang¹,

Kim²,

Kwon³

et al. 2021

Dig Dis

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Background/Aim: Antimicrobial resistance significantly affects the cure rate of Helicobacter pylori (H. pylori) eradication. We evaluated the risk factor of failure in ultimate H. pylori eradication and assessed the efficacy of current regimens to overcome antibiotic resistance. Methods: Patients with H. pylori infection were prospectively enrolled in a single center. They were classified into three groups according to the previous history of H. pylori eradication, and antibiotic susceptibility was evaluated by culture and minimum inhibitory concentrations (MIC). Results: 97 patients successfully H. pylori cultured and 81 (83.5%), 7 (7.2%), and 9 (9.3%) were classified into primary resistance, 1st eradication failure, and 2nd or more eradication failure groups; the resistance to clarithromycin (CLA), metronidazole (MET), and levofloxacin (LEV) increased in the 1st eradication failure (85.7%, 57.1%, and 42.9%) and 2nd and more eradication failure (88.9%, 88.9%, and 55.6%) groups. The prevalence of MDR was 21.0% (17/81), 57.1% (4/7), and 88.9% (8/9) in the primary, 1st eradication failure, and 2nd or more eradication failure groups, respectively. In multivariate analysis, dual CLA/MET resistance (CLA/MET-R) (OR=31.432, 95% CI: 3.094–319.266, P=0.004) were independent risk factors for ultimate H. pylori eradication failure. In patients with dual CLA/MET-R, the eradication ratio of concomitant therapy was 57.1% (4/7), whereas that of bismuth-containing quadruple therapy was 27.3% (3/11) (P=0.350). Conclusions: Dual CLA/MET-R was the main cause of failure in ultimate H. pylori eradication, and 7 days- bismuth quadruple or concomitant regimen would not be suitable for H. pylori eradication in dual CLA/MET-R group.

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Empiric Versus Clarithromycin Resistance–Guided Therapy for Helicobacter pylori Based on Polymerase Chain Reaction Results in Patients With Gastric Neoplasms or Gastric Mucosa-Associated Lymphoid Tissue Lymphoma: A Randomized Controlled Trial

Kim¹,

Cho²,

Chung³

et al. 2020

Clin Transl Gastroenterol

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INTRODUCTION: We investigated to compare the effect of empirical therapy vs clarithromycin resistance–guided tailored therapy (tailored therapy) for eradication of Helicobacter pylori . METHODS: In this prospective, single center, open-label randomized controlled trial, we enrolled 72 patients with H. pylori infection from January 2019 through June 2019 in Korea. The patients were randomly assigned to both groups received empirical (n = 36) or tailored therapy (n = 36). Empirical therapy was defined as triple therapy with esomeprazole, amoxicillin, and clarithromycin for 10 days irrespective of clarithromycin resistance. Tailored therapy was triple or quadruple therapy with esomeprazole, metronidazole, tetracycline, and bismuth for 10 days based on genotype markers of resistance determined by gastric biopsy. Resistance-associated mutations in 23S rRNA were confirmed by multiplex polymerase chain reaction. Eradication status was assessed by 13 C-urea breath test, and the primary outcome was eradication rates. RESULTS: H . pylori was eradicated in 27 patients (75.0%), given empirical therapy and 32 patients (88.9%) treated with tailored therapy ( P = 0.136) in intention-to-treat analysis. In per protocol analysis, the eradication rate was 97.0% and 81.8% in tailored vs empirical groups ( P = 0.046). Although clarithromycin-resistant H. pylori was eradicated in 3/9 (33.3%) with empirical therapy, it was treated in 11/12 (91.7%) with tailored therapy ( P = 0.009). There was no difference in compliance between 2 groups. The rate of adverse events of the tailored group was higher than that of the empirical group ( P = 0.036) because quadruple therapy had more side effects than those of triple therapy ( P = 0.001). DISCUSSION: Tailored therapy based on polymerase chain reaction is a good alternative to increase eradication rates in a region of high prevalence of clarithromycin resistance (see Visual Abstract, Supplementary Digital Content 1, http://links.lww.com/CTG/A342 ).

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A Pilot Study ofHelicobacter pyloriEradication Using a Polymerase Chain Reaction-based Test for Clarithromycin Resistance

Cited by 4 publications

References 41 publications

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

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

Dual Clarithromycin and Metronidazole Resistance Is the Main Cause of Failure in Ultimate <b><i>Helicobacter pylori</i></b> Eradication

Empiric Versus Clarithromycin Resistance–Guided Therapy for Helicobacter pylori Based on Polymerase Chain Reaction Results in Patients With Gastric Neoplasms or Gastric Mucosa-Associated Lymphoid Tissue Lymphoma: A Randomized Controlled Trial

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