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. 2021 Feb 21;10(2):214.
doi: 10.3390/antibiotics10020214.

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

Seokin Kang  1 , Yuri Kim  1 , Ji Yong Ahn  1 , Hwoon-Yong Jung  1 , Nayoung Kim  2 , Hee Kyong Na  1 , Jeong Hoon Lee  1 , Kee Wook Jung  1 , Do Hoon Kim  1 , Kee Don Choi  1 , Ho June Song  1 , Gin Hyug Lee  1
Affiliations

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

Seokin Kang et al. Antibiotics (Basel). .

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.

Keywords: Helicobacter infection; Helicobacter pylori; clarithromycin; microbial drug resistance; microbial sensitivity tests.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
Comparison of the eradication rates between triple therapy and sequential therapy according to clarithromycin susceptibility.
Figure 1
Figure 1
Flowchart of the process of patient enrollment.
Figure 2
Figure 2
Comparison of the eradication rates between the susceptibility-guided therapy group and the empirical therapy group.
Figure 3
Figure 3
Antimicrobial susceptibility of the susceptibility-guided therapy and the empirical therapy groups. CLR, clarithromycin; AMX, amoxicillin; MDZ, metronidazole; S, susceptible; R, resistant.
See this image and copyright information in PMC

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