Is tailored therapy based on antibiotic susceptibility effective ? a multicenter, open-label, randomized trial

Area of Science:

• Gastroenterology
• Infectious Diseases
• Clinical Microbiology

Background:

• Helicobacter pylori (H. pylori) eradication therapy requires optimization, especially in regions with high antibiotic resistance.
• Traditional H. pylori treatment regimens may be less effective due to increasing antimicrobial resistance patterns.
• Understanding factors contributing to treatment failure is essential for developing effective eradication strategies.

Purpose of the Study:

• To compare the efficacy of tailored therapy based on antibiotic susceptibility testing versus traditional therapy for H. pylori eradication.
• To evaluate factors influencing treatment failure in high-resistance areas.
• To identify the most effective eradication regimen in regions with significant antibiotic resistance.

Main Methods:

• A multicenter trial involving 467 H. pylori-positive patients randomized into three groups: tailored triple therapy (TATT), tailored bismuth-containing quadruple therapy (TABQT), and traditional bismuth-containing quadruple therapy (TRBQT).
• Antibiotic selection for TATT and TABQT groups was guided by susceptibility testing using an agar-dilution method.
• TRBQT group received amoxicillin, clarithromycin, esomeprazole, and bismuth. Eradication was confirmed by 13C-urea breath test.

Main Results:

• High resistance rates were observed for clarithromycin (26.12%), levofloxacin (28.69%), and metronidazole (96.79%).
• Intention-to-treat (ITT) eradication rates were: TATT 67.32%, TRBQT 63.69%, and TABQT 85.99% (P < 0.001).
• Per-protocol (PP) eradication rates were: TATT 74.64%, TRBQT 68.49%, and TABQT 91.22% (P < 0.001). TABQT showed superior efficacy, influenced by clarithromycin resistance.

Conclusions:

• Tailored bismuth-containing quadruple therapy (TABQT) is the most efficacious regimen for H. pylori eradication in high-resistance regions.
• Antibiotic susceptibility testing is vital for tailoring H. pylori treatment and improving eradication success.
• Bismuth's role in treatment failure for TATT highlights the importance of regimen composition in resistant areas.