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  • Pretreatment antimicrobial susceptibility-guided vs. clarithromycin-based triple therapy for Helicobacter pylori eradication in a region with high rates of multiple drug resistance.

Pretreatment antimicrobial susceptibility-guided vs. clarithromycin-based triple therapy for Helicobacter pylori eradication in a region with high rates of multiple drug resistance.

The American journal of gastroenterology (2014-08-06)
Chung-Su Park, Su-Mi Lee, Chang-Hwan Park, Han-Ra Koh, Chung-Hwan Jun, Seon-Young Park, Wan-Sik Lee, Young-Eun Joo, Hyun-Soo Kim, Sung-Kyu Choi, Jong-Sun Rew
ABSTRACT

Helicobacter pylori eradication rates with clarithromycin-based triple therapy are declining, and an alternative strategy is needed urgently. We sought to compare the efficacy of pretreatment antimicrobial susceptibility-guided vs. clarithromycin-based triple therapy for H. pylori eradication in a region with high rates of multiple drug resistance. Consecutive H. pylori-infected patients with gastric epithelial neoplasms were randomized to receive antimicrobial susceptibility-guided therapy or clarithromycin-based triple therapy for 7 days. In patients in whom the infection was not eradicated, antibiotics were given according to an initial antimicrobial susceptibility test as a second-line therapy in both groups. Eradication rates, antibiotics resistance rates, and drug compliance owing to adverse effects were compared between the groups. In total, 114 patients were enrolled, and 112 completed the protocols. Drug compliance and side effects were similar between the groups. The intention-to-treat eradication rates were 94.7% (95% confidence interval (CI)=88.8-100%, 54/57) in the antimicrobial susceptibility-guided group and 71.9% (95% CI=60.2-83.5%, 41/57) in the clarithromycin-based triple therapy group after the initial treatment (P=0.002), whereas the per-protocol (PP) eradication rates were 96.4% (95% CI=91.5-100%, 54/56) in the antimicrobial susceptibility-guided group and 73.2% (95% CI=61.5-84.8%, 41/56) in the clarithromycin-based triple therapy group (P=0.001). In H. pylori with clarithromycin resistance, the eradication failure rate with first-line treatment was lower in the susceptibility-guided therapy group (0%, 0/12) compared with the clarithromycin-based triple therapy group (80.0%, 95% CI=59.7-100%, 12/15) by PP analysis (P<0.001). Pretreatment antimicrobial susceptibility-guided therapy is more effective than clarithromycin-based triple therapy for H. pylori eradication in a region with high rates of multiple drug resistance.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Clarithromycin, 96.0-102.0% (HPLC)
Clarithromycin for peak identification, European Pharmacopoeia (EP) Reference Standard
Clarithromycin, European Pharmacopoeia (EP) Reference Standard
USP
Clarithromycin, United States Pharmacopeia (USP) Reference Standard
Sigma-Aldrich
Clarithromycin, ≥95% (HPLC)
Supelco
Clarithromycin, Pharmaceutical Secondary Standard; Certified Reference Material
USP
Clarithromycin Identity, United States Pharmacopeia (USP) Reference Standard