title: Pretreatment antimicrobial susceptibility-guided vs. clarithromycin-based triple therapy for Helicobacter pylori eradication in a region with high rates of multiple drug resistance.
abstract: OBJECTIVE
  Helicobacter pylori eradication rates with clarithromycin-based triple therapy are declining, and an alternative strategy is needed urgently. We sought to compare the efficacy of pretreatment antimicrobial susceptibility-guided vs. clarithromycin-based triple therapy for H. pylori eradication in a region with high rates of multiple drug resistance.
  
  
  METHODS
  Consecutive H. pylori-infected patients with gastric epithelial neoplasms were randomized to receive antimicrobial susceptibility-guided therapy or clarithromycin-based triple therapy for 7 days. In patients in whom the infection was not eradicated, antibiotics were given according to an initial antimicrobial susceptibility test as a second-line therapy in both groups. Eradication rates, antibiotics resistance rates, and drug compliance owing to adverse effects were compared between the groups.
  
  
  RESULTS
  In total, 114 patients were enrolled, and 112 completed the protocols. Drug compliance and side effects were similar between the groups. The intention-to-treat eradication rates were 94.7% (95% confidence interval (CI)=88.8-100%, 54/57) in the antimicrobial susceptibility-guided group and 71.9% (95% CI=60.2-83.5%, 41/57) in the clarithromycin-based triple therapy group after the initial treatment (P=0.002), whereas the per-protocol (PP) eradication rates were 96.4% (95% CI=91.5-100%, 54/56) in the antimicrobial susceptibility-guided group and 73.2% (95% CI=61.5-84.8%, 41/56) in the clarithromycin-based triple therapy group (P=0.001). In H. pylori with clarithromycin resistance, the eradication failure rate with first-line treatment was lower in the susceptibility-guided therapy group (0%, 0/12) compared with the clarithromycin-based triple therapy group (80.0%, 95% CI=59.7-100%, 12/15) by PP analysis (P<0.001).
  
  
  CONCLUSIONS
  Pretreatment antimicrobial susceptibility-guided therapy is more effective than clarithromycin-based triple therapy for H. pylori eradication in a region with high rates of multiple drug resistance.
authors.affiliation: 1] Department of Internal Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Korea [2] The first two authors contributed equally to this work.
authors.forename: Chung-Su
authors.initials: CS
authors.lastname: Park
authors.affiliation: 1] Department of Internal Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Korea [2] The first two authors contributed equally to this work.
authors.forename: Su-Mi
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Chang-Hwan
authors.initials: CH
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Han-Ra
authors.initials: HR
authors.lastname: Koh
authors.affiliation: Department of Internal Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Chung-Hwan
authors.initials: CH
authors.lastname: Jun
authors.affiliation: Department of Internal Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Seon-Young
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Wan-Sik
authors.initials: WS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Young-Eun
authors.initials: YE
authors.lastname: Joo
authors.affiliation: Department of Internal Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Hyun-Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Sung-Kyu
authors.initials: SK
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Jong-Sun
authors.initials: JS
authors.lastname: Rew
mesh_terms: D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017291:Clarithromycin / Q000008:administration & dosage*; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000473:pathology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000382:microbiology / Q000473:pathology; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D013274:Stomach Neoplasms / Q000382:microbiology / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D000658:Amoxicillin; D017291:Clarithromycin