Role of Antimicrobial Susceptibility Testing before First-Line Treatment Containing Clarithromycin for Helicobacter pylori Eradication in the Clinical Setting

Abstract

Background: Checking Helicobacter pylori susceptibility tests in the clinical setting before first-line treatment is considered difficult. We compared susceptibility-guided therapy (SGT) with empirical therapy (ET) as a first-line treatment containing clarithromycin and investigated the eradication rate using antimicrobial susceptibility testing (AST). Methods: 257 patients with H. pylori infection, with AST, performed before the eradication of clarithromycin-containing regimens were enrolled and divided into two groups: the SGT and ET groups. Results: Eradication rates in the SGT and ET groups were 85.4% and 58.4% (P < 0.01), respectively. In triple therapy (TT), eradication rates of the SGT and ET groups were 85.1% and 56.6% (P < 0.01), respectively. In sequential therapy (SET), eradication rates of the SGT and ET groups were 86.2% and 65.6% (P = 0.06), respectively. According to AST, TT had an eradication rate of 84.6% with strains susceptible to clarithromycin and amoxicillin and 11.1% with strains resistant to both. SET had an eradication rate of 89.5% with strains susceptible to clarithromycin, amoxicillin, and metronidazole, whereas it was 0% with strains resistant to clarithromycin and metronidazole. Conclusions: SGT as first-line treatment improved eradication rates of TT and SET by 28.5 (P < 0.01) and 20.6 (P = 0.06) percent points, respectively, compared with ET.

Susceptibility testing alone will not reliably achieve high Helicobacter pylori cure rates: A systematic review and meta‐analysis

“…Studies reporting duplicate data were excluded. After careful evaluation of the full texts, 48 studies reported detailed regimen and their eradication rates according to antibiotic resistances were finally included 4,5,12–57 …”

Changing profile of Helicobacter pylori primary antibiotic resistance in Singapore over two decades

“…It would appear logical to do so, especially since H. pylori eradication is not an emergency treatment and treatment can be deferred till results are available. However, the positive impact appears to be more significant for regions with high antibiotic resistance rates or low treatment success rates with empiric therapy 32,33 . In countries with a high empiric treatment success rate, this approach would not provide additional value and will not be cost‐effective 33,34 .…”

“…However, the positive impact appears to be more significant for regions with high antibiotic resistance rates or low treatment success rates with empiric therapy. 32,33 In countries with a high empiric treatment success rate, this approach would not provide additional value and will not be costeffective. 33,34 Routine antibiotic susceptibility testing will not be costeffective in Singapore, given the current high treatment success rates with empiric therapy.…”

Adherence to international guidelines for the management ofHelicobacter pyloriinfection among gastroenterologists and gastroenterology fellows in Italy: A Survey of the Italian Federation of Digestive Diseases ‐ FISMAD

“…In the future, molecular tests applied to fecal samples, if proven reliable, can help improving the assessment of antibiotic resistance of H. pylori , thus obviating the need for endoscopy 21 . Indeed, a susceptibility‐guided first‐line therapy could improve the efficacy of eradication regimen, decrease indirect costs related to treatment failure, and counteract the increasing emergence of antimicrobial‐resistant H. pylori strains 22–24 …”

“… 21 Indeed, a susceptibility‐guided first‐line therapy could improve the efficacy of eradication regimen, decrease indirect costs related to treatment failure, and counteract the increasing emergence of antimicrobial‐resistant H. pylori strains. 22 , 23 , 24 …”