Susceptibility-guided therapy for Helicobacter pylori infection treatment failures

Lou Yu, Laisheng Luo, Xiaohua Long, Xiao Liang, Yingjie Ji, Qi Chen, Yanyan Song, Xiaobo Li, David Y Graham, Hong Lu, Lou Yu, Laisheng Luo, Xiaohua Long, Xiao Liang, Yingjie Ji, Qi Chen, Yanyan Song, Xiaobo Li, David Y Graham, Hong Lu

Abstract

Background: Empirical therapy of Helicobacter pylori frequently results in treatment failure due to unrecognized antimicrobial resistance. The aim of this study was to investigate the effectiveness of susceptibility-guided therapy for rescue treatment of H. pylori infection in China.

Methods: This was a prospective study of consecutive 200 patients infected with H. pylori with one or more treatment failures. The therapy chosen was susceptibility based using the most effective, best-tolerated regimens first and a locally proven, reliably effective regimen for multidrug-resistant infections. All patients received 14-day triple therapy, i.e. esomeprazole 20 mg and amoxicillin 1 g twice a day plus clarithromycin 500 mg twice a day, metronidazole 400 mg twice a day, or levofloxacin 500 mg daily, or, for multidrug-resistant infections, amoxicillin-containing bismuth quadruple therapy with esomeprazole 20 mg twice a day, bismuth 220 mg twice a day, amoxicillin 1 g three times a day, and metronidazole 400 mg four times a day. Antibiotic resistance was determined by agar dilution.

Results: The eradication rate of susceptibility-guided therapy overall was 94.5% (189/200, 95% confidence interval: 90.4-97.2%). Around 28% (56/200) of patients carried strains susceptible to one of the tested antibiotics and were prescribed the triple therapy. A total of 144 multidrug-resistant patients received bismuth quadruple therapy. The eradication rates were all greater than 90%, i.e. 91.7% (11/12), 92.3% (12/13), and 93.5% (29/31) in those who received clarithromycin, metronidazole, and levofloxacin-containing triple therapy and 95.1% (137/144) for the bismuth quadruple therapy. There were no differences in eradication rates between the subgroups.

Conclusions: Although susceptibility-guided therapy proved high efficacious despite the high proportion of multidrug-resistant strains, the strategy suggested the best approach for this population would be empirical amoxicillin-containing bismuth quadruple therapy. ClinicalTrials.gov identifier: NCT03413020.

Keywords: Helicobacter pylori; rescue treatment; susceptibility-guided therapy.

Conflict of interest statement

Conflict of interest statement: DYG is a consultant for RedHill Biopharma regarding novel H. pylori therapies. He has received research support for the culture of Helicobacter pylori and is the PI of an international study of the use of antimycobacterial therapy for Crohn’s disease. He is also a consultant for BioGaia in relation to probiotic therapy for H. pylori infection and for Takeda in relation to H. pylori therapies.

Figures

Figure 1.
Figure 1.
Design of susceptibility-guided therapy.
Figure 2.
Figure 2.
Flow diagram of this study. EAC, esomeprazole, amoxicillin, and clarithromycin; EAM, esomeprazole, amoxicillin, and metronidazole; EAL, esomeprazole, amoxicillin, and levofloxacin; EBAM, esomeprazole, bisMUTh, amoxicillin, and metronidazole; ITT, intention-to-treat; PP, per-protocol; 13C-UBT, 13C-urea breath test.

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Source: PubMed

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