title: Antimicrobial Susceptibility-Guided Therapy Versus Empirical Concomitant Therapy for Eradication of Helicobacter pylori in a Region with High Rate of Clarithromycin Resistance.
abstract: BACKGROUND
  Nonbismuth quadruple (concomitant) regimen is recommended for first-line empirical Helicobacter pylori (HP) eradication treatment when clarithromycin resistance is more than 15-20%. Our objective was to evaluate the efficacy and tolerability of concomitant versus antimicrobial susceptibility-guided treatment in an area with high rates of clarithromycin resistance.
  
  
  METHODS
  Three hundred consecutive HP-infected patients received antimicrobial susceptibility-guided therapy or empirical concomitant therapy for 10 days. The concomitant regimen was omeprazole (20 mg/12 hour), amoxicillin (1 g/12 hour), clarithromycin (500 mg/12 hour), and metronidazole (500 mg/12 hour) (OACM). Patients diagnosed by culture received one of three combinations of antibiotics based on susceptibility results: omeprazole, amoxicillin, and clarithromycin (OAC); omeprazole, amoxicillin, and levofloxacin (OAL); or omeprazole, amoxicillin, and metronidazole (OAM), at the aforementioned doses (and 500 mg/12 hour in the case of levofloxacin). Eradication was confirmed with a (13)C urea breath test, 6 weeks after treatment. Adverse events and adherence were assessed with questionnaires and reviewing medication sachets.
  
  
  RESULTS
  The mean age was 50 years, 59% were women, and 14% had peptic ulcers. Concomitant and antimicrobial susceptibility-guided eradication rates were, respectively, 87% and 94% by intention-to-treat (p = .08) and 89% and 95% (p = .08) per protocol per-protocol analysis. Adverse effects were reported in 31% of patients on OACM and 15% of those on susceptibility-guided therapy (p < .05).
  
  
  CONCLUSIONS
  For HP eradication in a region with high rates of multiple drug resistance, antimicrobial susceptibility-guided therapy is more effective than empirical concomitant therapy.
authors.affiliation: Gastroenterology Department, Donostia Hospital-Biodonostia Health Research Institute, University of Basque Country (UPV/EHU), Centro de Investigación Biomédica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), San Sebastián, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Cosme
authors.affiliation: Gastroenterology Department, Donostia Hospital-Biodonostia Health Research Institute, University of Basque Country (UPV/EHU), Centro de Investigación Biomédica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), San Sebastián, Spain.
authors.forename: Jacobo
authors.initials: J
authors.lastname: Lizasoan
authors.affiliation: Microbiology Department, Hospital Universitario Donostia - Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), San Sebastián, Spain.
authors.forename: Milagrosa
authors.initials: M
authors.lastname: Montes
authors.affiliation: Microbiology Department, Hospital Universitario Donostia - Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), San Sebastián, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Tamayo
authors.affiliation: Gastroenterology Department, Donostia Hospital-Biodonostia Health Research Institute, University of Basque Country (UPV/EHU), Centro de Investigación Biomédica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), San Sebastián, Spain.
authors.forename: Horacio
authors.initials: H
authors.lastname: Alonso
authors.affiliation: Gastroenterology Department, Donostia Hospital-Biodonostia Health Research Institute, University of Basque Country (UPV/EHU), Centro de Investigación Biomédica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), San Sebastián, Spain.
authors.forename: Usua
authors.initials: U
authors.lastname: Mendarte
authors.affiliation: Gastroenterology Department, Donostia Hospital-Biodonostia Health Research Institute, University of Basque Country (UPV/EHU), Centro de Investigación Biomédica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), San Sebastián, Spain.
authors.forename: Maider
authors.initials: M
authors.lastname: Martos
authors.affiliation: Microbiology Department, Hospital Universitario Donostia - Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), San Sebastián, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Fernández-Reyes
authors.affiliation: Epidemiology Department, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Donostia Hospital, San Sebastián, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Saraqueta
authors.affiliation: Gastroenterology Department, Donostia Hospital-Biodonostia Health Research Institute, University of Basque Country (UPV/EHU), Centro de Investigación Biomédica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), San Sebastián, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Bujanda
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017291:Clarithromycin / Q000008:administration & dosage*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D017291:Clarithromycin
keywords: Helicobacter pylori; concomitant; resistance; susceptibility; therapy