Pretreatment antimicrobial susceptibility testing is cost saving in the eradication of Helicobacter pylori.
OBJECTIVE
The major obstacle to 100% effective eradication of Helicobacter pylori infection is represented by antimicrobial-resistant H. pylori strains. This randomized study was designed to evaluate whether regimens based on pretreatment susceptibility testing were more effective and cost saving compared with standard nonsusceptibility testing-based therapy in the eradication of H. pylori infection.


METHODS
We studied 150 consecutive H. pylori-infected dyspeptic subjects. Patients were randomly assigned to omeprazole 20 mg twice daily, clarithromycin 500 mg twice daily, and metronidazole 500 mg twice daily for 7 days or to omeprazole 20 mg twice daily and 2 antimicrobials chosen based on susceptibility testing. H. pylori status was reevaluated 12 weeks after the end of treatment by the (13)C-urea breath test.


RESULTS
Susceptibility testing-based regimens led to the following results. (1) Eradication rates were 97.3% (95% confidence interval [CI], 91.2%-99.5%) (71 of 73) and 94.6% (95% CI, 87.6%-98.3%) (71 of 75) in the per-protocol and intention-to-treat analysis, respectively. These were significantly higher (P < 0.005) than eradication rates obtained without susceptibility testing, that is, 79.4% (95% CI, 69.1%-87.6%) (58 of 73) and 77.3% (95% CI, 66.9%-85.7%) (58 of 75) in the per-protocol and intention-to-treat analyses, respectively. (2) There were savings of approximately $5 U.S. per patient compared with standard triple therapy.


CONCLUSIONS
Pretreatment antimicrobial susceptibility testing is more effective and cost saving and, in health systems that confirm cost advantage, microbial susceptibility testing should be routinely used for eradication of H. pylori infection.
Romano
Marco
M
Dipartimento di Internistica Clinica e Sperimentale, Cattedra di Gastroenterologia, Seconda Università di Napoli, c/o II Policlinico, Bldg. 3, 2nd Floor, Via Pansini 5, Naples, Italy. marco.romano@unina2.it
Marmo
Riccardo
R
Cuomo
Antonio
A
De Simone
Teresa
T
Mucherino
Caterina
C
Iovene
Maria Rosaria
MR
Montella
Fortunato
F
Tufano
Maria Antonietta
MA
Del Vecchio Blanco
Camillo
C
Nardone
Gerardo
G
D000328:Adult; D000658:Amoxicillin / Q000191:economics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use; D017291:Clarithromycin / Q000191:economics / Q000627:therapeutic use; D017046:Cost Savings; D003362:Cost-Benefit Analysis / Q000191:economics; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008795:Metronidazole / Q000191:economics / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests / Q000191:economics; D008875:Middle Aged; D009853:Omeprazole / Q000191:economics / Q000627:therapeutic use; D015995:Prevalence; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000191:economics / Q000627:therapeutic use; D013223:Statistics as Topic; D013752:Tetracycline / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D017494:Proton Pumps; D008795:Metronidazole; D000658:Amoxicillin; D013752:Tetracycline; D017291:Clarithromycin; D009853:Omeprazole