Cost‐effectiveness of a tailored <i>Helicobacter pylori</i> eradication strategy based on the presence of a 23<scp>S</scp> ribosomal RNA point mutation that causes clarithromycin resistance in Korean patients

Cho, Jun-Hyung; Jeon, Seong Ran; Kim, Hyun Gun; Jin, So-Young; Park, Suyeon

doi:10.1111/jgh.14383

Cited by 59 publications

(72 citation statements)

References 37 publications

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“…Although it is not clear why this rate seems to have decreased, the high MIC point in our current histogram was 2 µm/mL, which compared very favorably with previous results (4 µm/mL in 1987, 32 µm/mL in 1994, and 64 µm/mL in 2003) . Bismuth‐based quadruple therapy including metronidazole is an accepted alternative treatment to clarithromycin‐based triple therapy for H. pylori in Korea as it has shown favorable outcomes in recent studies …”

Section: Discussionsupporting

confidence: 83%

Nationwide antibiotic resistance mapping of Helicobacter pylori in Korea: A prospective multicenter study

et al. 2019

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Introduction The eradication rates for Helicobacter pylori have decreased in Korea although the prevalence of this bacterium has also decreased. Antibiotic resistance is likely to be a crucial factor in H. pylori eradication success, and we therefore mapped these resistance patterns nationwide in Korea. Materials and Methods Five hundred and ninety adult subjects were prospectively enrolled from 2017 to 2018 from 15 centers across six geographic areas of Korea. A total of 580 biopsy tissues had been sampled from these patients during an upper endoscopy and were frozen at −80°C and delivered to a central laboratory. The agar dilution method was used to determine the minimum inhibitory concentration of amoxicillin, clarithromycin, metronidazole, tetracycline, ciprofloxacin, and levofloxacin for each H. pylori isolate. Results The culture success rate was 60.2% (349/580). Resistance rates against clarithromycin, metronidazole, amoxicillin, tetracycline, levofloxacin, and ciprofloxacin were 17.8%, 29.5%, 9.5%, 0%, 37.0%, and 37.0%, respectively. The geographic distribution of metronidazole and quinolone resistance was highly variable. Some subjects had multiple H. pylori strains in the antrum and body of the stomach and showed a heterogeneous resistance profile between these anatomic areas. The H. pylori multidrug resistance (MDR) rate was 25.2% (88/349) among amoxicillin, clarithromycin, metronidazole, tetracycline, and quinolone and 11.2% (39/349) among four of these major antibiotics except for quinolone. The Seoul and Chungcheong areas showed a relatively lower MDR rate. Conclusion The antibiotic resistance of H. pylori differs by drug and geographic area in Korea. Detailed nationwide antibiotic resistance mapping is needed to develop an effective H. pylori eradication strategy.

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Section: Discussionsupporting

confidence: 83%

Nationwide antibiotic resistance mapping of Helicobacter pylori in Korea: A prospective multicenter study

et al. 2019

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“…30 Bazin et al analyzed the impact of PPI medication on the H. pylori positivity of histology, immunohistochemistry, culture, and an inhouse real-time PCR. 35,36 In another study, the amplification refractory mutation system combined with quantitative real-time PCR (ARMS-PCR) was used to detect point mutations associated with clarithromycin resistance in gastric biopsies of patients who failed H. pylori eradication treatment. 31 Another study confirmed the lower sensitivity of culture to detect H. pylori infection in patients who had received eradication therapy one or more times in the past compared to its performance in naïve patients; this was explained by lower bacterial density and migration from antrum to corpus after eradication failure.…”

Section: Molecular Methodsmentioning

confidence: 99%

Review: Diagnosis of Helicobacter pylori infection

et al. 2019

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Endoscopic imaging of the stomach is improving. In addition to narrow band imaging, other methods, for example, blue light imaging and linked color imaging, are now available and can be combined with artificial intelligence systems to obtain information on the gastric mucosa and detect early gastric cancer. Immunohistochemistry is only recommended as an ancillary stain in case of chronic active gastritis without Helicobacter pylori detection by standard staining, and recommendations to exclude false negative H. pylori results have been made. Molecular methods using real‐time PCR, droplet digital PCR, or amplification refractory mutation system PCR have shown a high accuracy, both for detecting H. pylori and for clarithromycin susceptibility testing, and can now be used in clinical practice for targeted therapy. The most reliable non‐invasive test remains the 13C‐urea breath test. Large data sets show that DOB values are higher in women and that the cut‐off for positivity could be decreased to 2.74 DOB. Stool antigen tests using monoclonal antibodies are widely used and may be a good alternative to UBT, particularly in countries with a high prevalence of H. pylori infection. Attempts to improve serology by looking at specific immunodominant antigens to distinguish current and past infection have been made. The interest of Gastropanel® which also tests pepsinogen levels was confirmed.

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“…Actually, molecular tests are advantageous: firstly, the process is simple and time‐saving; moreover, clinicians can easily obtain stool samples or gastric specimens through endoscopic biopsies. Hence, it is worthwhile to further estimate the value of molecular tests for antimicrobial resistance . In our preliminary study, the accuracy of CLA resistance between DPO‐based multiplex PCR and culture‐based MIC was 90.3%, and there was one case with CLA and Metro dual resistance caught by culture/MIC but it was missed by DPO‐PCR method (Table ) .…”

Section: Discussionmentioning

confidence: 86%

“…Recently, pretreatment susceptibility testing was performed by several studies to avoid antibiotic resistance . In terms of ease of diagnosis and economic efficiency, a recent study demonstrated that the PCR test using tissue samples processed using rapid urease test was appropriate for detecting H pylori . Generally, resistance to CLA is known to be mediated by the point mutations in the 23S rRNA gene at position 2142 or 2143 (A2143G, A2142G, and A2142C of domain V) .…”

Section: Discussionmentioning

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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Cost‐effectiveness of a tailored Helicobacter pylori eradication strategy based on the presence of a 23S ribosomal RNA point mutation that causes clarithromycin resistance in Korean patients

Abstract: In Korea, tailored H. pylori eradication using DPO-PCR may be more cost-effective than conventional triple therapy.

Cited by 59 publications

References 37 publications

Nationwide antibiotic resistance mapping of Helicobacter pylori in Korea: A prospective multicenter study

Nationwide antibiotic resistance mapping of Helicobacter pylori in Korea: A prospective multicenter study

Review: Diagnosis of Helicobacter pylori infection

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

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