title: Comparison of the efficacy of culture-based tailored therapy for Helicobacter pylori eradication with that of the traditional second-line rescue therapy in Korean patients: a prospective single tertiary center study.
abstract: OBJECTIVE
  The effectiveness of Helicobacter pylori therapies has declined with an increase in antibiotic resistance. To overcome this problem, the efficacy of tailored H. pylori eradication therapy based on antimicrobial susceptibility testing was compared with that of empirical second-line rescue regimens.
  
  
  METHODS
  Patients who had persistent H. pylori infection after the first eradication were recommended to undergo culture for determining the minimal inhibitory concentration (MIC) via gastroscopy, which increased the cost by 300%. Fourteen-day esomeprazole, tripotassium dicitrate bismuthate, metronidazole and tetracycline (EBMT) therapy or esomeprazole, moxifloxacin and amoxicillin (MEA) therapy was performed according to the results of antibiotic susceptibility testing. In case of refusal to undergo culture, the participants were treated with either 14-day empirical EBMT or MEA regimen for second eradication after explaining the complexity, side effects and costs associated with each regimen. This trial was registered at ClinicalTrials.Gov (NCT 02349685).
  
  
  RESULTS
  In the 219 patients included, the intention to treat (ITT) and per protocol (PP) eradication rates was 75.3% and 79.8% in the 14-day EBMT group (n = 89), 70.8% and 72.4% in the 14-day MEA group (n = 89) and 87.8% and 100.0% in the 14-day tailored therapy group (n = 41), respectively. Based on the PP analysis, the 14-day tailored therapy group showed a significantly higher eradication rate than the 14-day EBMT or MEA group (both p ≤ 0.001).
  
  
  CONCLUSIONS
  Tailored therapy based on H. pylori culture and MIC test could be an option as a second-line eradication regimen in the presence of high level of antimicrobial resistance.
authors.affiliation: a Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , South Korea ;|b Department of Internal Medicine , Kyungpook National University Hospital , Daegu , South Korea ;
authors.forename: Yong Hwan
authors.initials: YH
authors.lastname: Kwon
authors.affiliation: a Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , South Korea ;|c Department of Internal Medicine and Liver Research Institute , Seoul National University College of Medicine , Seoul , South Korea.
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.affiliation: a Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , South Korea ;
authors.forename: Ju Yup
authors.initials: JY
authors.lastname: Lee
authors.affiliation: a Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , South Korea ;
authors.forename: Yoon Jin
authors.initials: YJ
authors.lastname: Choi
authors.affiliation: a Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , South Korea ;
authors.forename: Kichul
authors.initials: K
authors.lastname: Yoon
authors.affiliation: a Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , South Korea ;
authors.forename: Ryung Hee
authors.initials: RH
authors.lastname: Nam
authors.affiliation: a Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , South Korea ;
authors.forename: Ji Hyung
authors.initials: JH
authors.lastname: Suh
authors.affiliation: c Department of Internal Medicine and Liver Research Institute , Seoul National University College of Medicine , Seoul , South Korea.
authors.forename: Jung Won
authors.initials: JW
authors.lastname: Lee
authors.affiliation: a Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , South Korea ;|c Department of Internal Medicine and Liver Research Institute , Seoul National University College of Medicine , Seoul , South Korea.
authors.forename: Dong Ho
authors.initials: DH
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000191:economics / Q000379:methods; D064098:Esomeprazole / Q000627:therapeutic use; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D000077266:Moxifloxacin; D009942:Organometallic Compounds / Q000627:therapeutic use; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D056910:Republic of Korea; D062606:Tertiary Care Centers; D013752:Tetracycline / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D009942:Organometallic Compounds; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D013752:Tetracycline; C002791:bismuth tripotassium dicitrate; D064098:Esomeprazole; D000077266:Moxifloxacin
keywords: Antimicrobial resistance; Helicobacter pylori eradication; bismuth; metronidazole; moxifloxacin