title: Pretreatment antimicrobial susceptibility testing is cost saving in the eradication of Helicobacter pylori.
abstract: 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.
authors.affiliation: 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
authors.forename: Marco
authors.initials: M
authors.lastname: Romano
authors.forename: Riccardo
authors.initials: R
authors.lastname: Marmo
authors.forename: Antonio
authors.initials: A
authors.lastname: Cuomo
authors.forename: Teresa
authors.initials: T
authors.lastname: De Simone
authors.forename: Caterina
authors.initials: C
authors.lastname: Mucherino
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Iovene
authors.forename: Fortunato
authors.initials: F
authors.lastname: Montella
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Tufano
authors.forename: Camillo
authors.initials: C
authors.lastname: Del Vecchio Blanco
authors.forename: Gerardo
authors.initials: G
authors.lastname: Nardone
mesh_terms: 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
chemical_list: 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