title: Susceptibility-guided vs. empiric retreatment of Helicobacter pylori infection after treatment failure.
abstract: Successful eradication of Helicobacter pylori after failure of standard triple therapy is difficult because of the higher resistance to metronidazole and clarithromycin. We evaluated the efficacy of susceptibility-guided vs. empiric retreatment for H. pylori after at least one treatment failure and determined the prevalence of posttreatment antibiotic resistance. Forty-nine patients in whom at least one treatment regimen for H. pylori eradication had failed underwent gastric biopsy and culture and were retreated according to the in vitro susceptibility results. Findings were compared with those for 49 control patients referred to our center for a (13)C-urea breath test. H. pylori eradication was assessed by urea breath test at least 6 weeks after retreatment in both groups. Susceptibility-guided retreatment was associated with better eradication rates than empiric treatment. The difference remained significant in stratified and multivariate analysis. Susceptibility-guided retreatment appears to be significantly more effective than empiric retreatment in eradicating H. pylori after at least one previous treatment failure.
authors.affiliation: Helicobacter Research Institute, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Yahav
authors.forename: Zmira
authors.initials: Z
authors.lastname: Samra
authors.forename: Yaron
authors.initials: Y
authors.lastname: Niv
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Passaro
authors.forename: Gabriel
authors.initials: G
authors.lastname: Dinari
authors.forename: Haim
authors.initials: H
authors.lastname: Shmuely
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001706:Biopsy; D002478:Cells, Cultured; D017291:Clarithromycin / Q000627:therapeutic use; D015331:Cohort Studies; D004198:Disease Susceptibility / Q000382:microbiology* / Q000473:pathology*; D024881:Drug Resistance, Bacterial; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000473:pathology*; D016480:Helicobacter pylori / Q000472:pathogenicity; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D015995:Prevalence; D013270:Stomach / Q000187:drug effects / Q000382:microbiology / Q000473:pathology; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D017291:Clarithromycin