title: Tailored eradication therapy based on fecal Helicobacter pylori clarithromycin sensitivities.
abstract: 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.
authors.affiliation: Endoscopy Center, Tokyo Medical University, Tokyo, Japan. t-kawai@tokyo-med.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawai
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yamagishi
authors.forename: Kenji
authors.initials: K
authors.lastname: Yagi
authors.forename: Mikinori
authors.initials: M
authors.lastname: Kataoka
authors.forename: Kohei
authors.initials: K
authors.lastname: Kawakami
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sofuni
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakai
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Osaka
authors.forename: Yu
authors.initials: Y
authors.lastname: Takagi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Aoki
authors.forename: Emiko
authors.initials: E
authors.lastname: Rimbara
authors.forename: Norihisa
authors.initials: N
authors.lastname: Noguchi
authors.forename: Masanori
authors.initials: M
authors.lastname: Sasatsu
mesh_terms: 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
chemical_list: 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