title: Outcome of second- and third-line Helicobacter pylori eradication therapies based on antimicrobial susceptibility testing.
abstract: OBJECTIVE
  The objective of this study was to assess the outcome of antimicrobial susceptibility-guided therapies in Helicobacter pylori-infected individuals who had undergone unsuccessful prior eradication treatments.
  
  
  METHODS
  From October 2004 to December 2013, 481 H. pylori-positive patients with prior unsuccessful eradication treatments were administered susceptibility-guided salvage eradication treatments. Six months on, treatment outcome was assessed by urea breath test, stool antigen ELISA, Helicobacter urease test or microbiology and/or histopathology.
  
  
  RESULTS
  Resistance to metronidazole and clarithromycin was high in patients with prior unsuccessful eradication treatments and was dependent on the number of treatment failures. Susceptibility-guided salvage eradication treatments achieved eradication rates of nearly 70% in these patients. No particular regimen was significantly better than another.
  
  
  CONCLUSIONS
  Antimicrobial susceptibility testing prevents prescription of inefficient antimicrobials and enables individualized and promising salvage treatments in patients with prior unsuccessful eradication treatments.
authors.affiliation: National Reference Centre for Helicobacter pylori, Department of Medical Microbiology and Hygiene, Institute of Medical Microbiology and Hygiene, University Medical Centre Freiburg, Hermann-Herder-Straße 11, 79104 Freiburg, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Draeger
authors.affiliation: National Reference Centre for Helicobacter pylori, Department of Medical Microbiology and Hygiene, Institute of Medical Microbiology and Hygiene, University Medical Centre Freiburg, Hermann-Herder-Straße 11, 79104 Freiburg, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Wüppenhorst
authors.affiliation: National Reference Centre for Helicobacter pylori, Department of Medical Microbiology and Hygiene, Institute of Medical Microbiology and Hygiene, University Medical Centre Freiburg, Hermann-Herder-Straße 11, 79104 Freiburg, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Kist
authors.affiliation: National Reference Centre for Helicobacter pylori, Department of Medical Microbiology and Hygiene, Institute of Medical Microbiology and Hygiene, University Medical Centre Freiburg, Hermann-Herder-Straße 11, 79104 Freiburg, Germany erik-oliver.glocker@uniklinik-freiburg.de.
authors.forename: Erik-Oliver
authors.initials: EO
authors.lastname: Glocker
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000942:Antigens, Bacterial / Q000032:analysis; D001706:Biopsy; D001944:Breath Tests; D004359:Drug Therapy, Combination / Q000379:methods; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000382:microbiology; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006651:Histocytochemistry; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome; D014508:Urea / Q000032:analysis
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D014508:Urea