Antibiotic Resistance and Results in Antibiogram–based Helicobacter Pylori Therapy in Gastritis Patients After Two or More Eradication Failures

Abstract

Background: The Maastricht IV consensus recommended that if patients who failed after two eradication attempts need to be treated with the third-line treatment based on the antimicrobial susceptibility. However, there was few researches in Vietnam about the true effectiveness of this approach. Objectives: To determine the antibiotic resistance prevalances of H.pylori and the success rates of antibiogram-based on H.pylori eradication treatment according to modified intention to treat and per protocol analysis. Method: This cross-sectional, intervention study involved 62 dyspeptic patients who had two or more eradication failures, examined at Thong Nhat-Dong Nai General Hospital from 05/2014- 05/2015, diagnosed gastritis endoscopically and H.pylori positive at rapid urease test. Antibiogram for H.pylori was used both to evaluate antibiotic resistance and to treat patients. Results: The prevalances of H.pylori resistance to AMX, CLR, LFX, MTZ, TET were7.6- 77.4- 66.1- 86.2- 1.7%, respectively. The rate of H.pylori strains resistance to LFX was significantly higher in female than in male, 75.0% versus 44.4%, OR = 0.3 (95% CI 0.1 - 0.8), p = 0.03. 90.6% of H.pylori strains were susceptible to both AMX and TET and 54.8% of those were resistant to both CLR and LFX. Using mITT and PP analysis, the success rates of antibiogram-based regimen were: 69.2% và 76.6%, respectively. Conclusion: In patients who failed two or more H.pylori eradication treatments, both AMX and TET were still susceptible. The rates of H.pylori strains were resistant to CLR, LFX and dual rather high. The efficacy of antibiogram-based H.pylorieradication treatment was acceptable. Key words: H.pylori, antibiotic resistance, antibiogram-based, eradication, failure, mITT, PP.