Tailored eradication therapy based on fecal Helicobacter pylori clarithromycin sensitivities.
OBJECTIVE
Helicobacter pylori (H. pylori) eradication rates using the PPI/AC regimen (proton pump inhibitor + amoxicillin + clarithromycin) are declining. We trialed tailoring eradication regimens according to clarithromycin (CAM) susceptibility.


METHODS
The subjects were 70 H. pylori positive adults. They were randomly allocated to a tailored group and a control group. In the tailored group, subjects with CAM-sensitive strains were given PPI/AC eradication therapy, and those with CAM-resistant strains were given PPI/AM (metronidazole instead of clarithromycin) therapy. The control group were all given PPI/AC therapy. CAM sensitivity was measured by collecting fecal specimens, and extracting the DNA. The 23S rRNA domain, associated with CAM susceptibility in H. pylori, was amplified using a nested polymerase chain reaction (PCR), and DNA sequencing was used to detect point mutations at A2143G and A2144G.


RESULTS
Eradication rates were 94.3% in the tailored group and 71.4% in the control group. In particular, the eradication rate was 100% for CAM-resistant strains in the tailored group.


CONCLUSIONS
In Japan, where CAM-resistant H. pylori strains are expected to continue to increase, tailored eradication therapy according to CAM sensitivity will be of benefit.
Kawai
Takashi
T
Endoscopy Center, Tokyo Medical University, Tokyo, Japan. t-kawai@tokyo-med.ac.jp
Yamagishi
Tetsuya
T
Yagi
Kenji
K
Kataoka
Mikinori
M
Kawakami
Kohei
K
Sofuni
Atsushi
A
Itoi
Takao
T
Sakai
Yoshihiro
Y
Moriyasu
Fuminori
F
Osaka
Yoshiaki
Y
Takagi
Yu
Y
Aoki
Tatsuya
T
Rimbara
Emiko
E
Noguchi
Norihisa
N
Sasatsu
Masanori
M
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D017291:Clarithromycin / Q000627:therapeutic use*; D065731:Cytochrome P-450 CYP2C19; D004269:DNA, Bacterial / Q000302:isolation & purification; D024881:Drug Resistance, Bacterial / Q000235:genetics; D004359:Drug Therapy, Combination; D005243:Feces / Q000382:microbiology*; D005260:Female; D005838:Genotype; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000235:genetics / Q000254:growth & development; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D018579:Patient Selection; D017354:Point Mutation; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D021521:Ribotyping; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D017291:Clarithromycin