Tailored Helicobacter pylori eradication based on prior intake of macrolide antibiotics allows the use of triple therapy with optimal results in an area with high clarithromycin resistance

Efficacy of bismuth‐based quadruple therapy for eradication of Helicobacter pylori infection based on previous antibiotic exposure: A large‐scale prospective, single‐center clinical trial in China

“…It was clearly demonstrated that all these three bismuth‐based quadruple therapies achieved eradication rates of >80% (ITT) and >90% (PP), indicating that the previous use of antibiotics can be used as a guide in clinical practice for eradicating H pylori infection. Indeed, a few studies have chosen the clarithromycin‐free and metronidazole‐free regimens for patients who previously used macrolide and nitroimidazole antibiotics, respectively, and most of these patients obtained satisfactory eradication rates 29‐32 . For example, Valle Muñoz et al achieved a high eradication rate (ITT: 85.9% and PP: 98.5%) with selective triple and quadruple regimens based on the previous use of macrolide antibiotics, which was slightly higher than the observed in the present study (ITT: 82.5%‐84.0% and PP: 92.2%‐94.6%).…”

“…At present, merely a few studies have explored this possibility 29‐31 . Valle‐Muñoz et al reported that a bismuth quadruple therapy consisting of omeprazole and a three‐in‐one capsule containing omeprazole, bismuth subcitrate, metronidazole, and tetracycline for 10 days achieved eradication rates of 85.9% and 98.5% in 78 Spanish patients with previous use of macrolides, as calculated through intention‐to‐treat (ITT) and per‐protocol (PP) analyses 32 . Kwon et al demonstrated eradication rates of 92.2% (ITT) and 94.0% (PP) in 51 Korean patients using 14‐day triple therapies tailored for resistance to clarithromycin and metronidazole based on antibiotic susceptibility testing and previous antibiotic exposure 33 .…”

“…Kwon et al demonstrated eradication rates of 92.2% (ITT) and 94.0% (PP) in 51 Korean patients using 14‐day triple therapies tailored for resistance to clarithromycin and metronidazole based on antibiotic susceptibility testing and previous antibiotic exposure 33 . However, these studies were limited to targeting a single or dual antibiotics, and the small number of patients, and the exclusion of patients with a previously failed eradication therapy 32,33 . In a preliminary study of 327 Chinese patients, eradication rates of 63.5%, 76.2%, and 82.6% (ITT) and 76.7%, 92.4%, and 96.4%(PP), respectively, were observed with bismuth‐based quadruple therapies with amoxicillin‐free, nitroimidazole‐free, and amoxicillin‐nitroimidazole‐clarithromycin‐free regimens 34 .…”

Antibiotic Resistance Prevalence and Trends in Patients Infected with Helicobacter pylori in the Period 2013–2020: Results of the European Registry on H. pylori Management (Hp-EuReg)

“…Antibiotic misuse is the primary cause of the increase in resistance. Exposure to antibiotics is very high: up to 46% of the patients for whom an eradication treatment was indicated had received macrolides (mainly clarithromycin and azithromycin) in the previous 12–14 years [ 9 ]. In this study, the exposure to other antibiotics as amoxicillin, metronidazole, and quinolones were 80%, 11%, and 4%, respectively [ 9 ].…”

“…Exposure to antibiotics is very high: up to 46% of the patients for whom an eradication treatment was indicated had received macrolides (mainly clarithromycin and azithromycin) in the previous 12–14 years [ 9 ]. In this study, the exposure to other antibiotics as amoxicillin, metronidazole, and quinolones were 80%, 11%, and 4%, respectively [ 9 ]. Throughout the period 2000–2010, global macrolide and fluoroquinolone consumption increased by 19% and 64%, respectively [ 10 , 11 ].…”