Characteristics of Successful Third-Line Eradication of Helicobacter pylori based on Antibiotic Susceptibility

Regimens using vonoprazan (VPZ), amoxicillin (AMX), and sitafloxacin (STFX) have been reported to be effective for the third-line eradication of Helicobacter pylori and are widely used in Japan. However, the outcomes of these therapies have only been reported by a limited number of institutions. We aimed to investigate the backgrounds and treatment outcomes of patients who underwent successful third-line eradication of H. pylori.

This was a single-center, retrospective, observational study included patients who underwent antibiotic susceptibility testing and third-line eradication of H. pylori between 2013 and 2020. We examined the success rates of the third-line regimens and compared the backgrounds and clinical characteristics of patients between the successful and failed eradication groups.

Fifty-three patients were enrolled. The overall success rate of third-line eradication was 79.2% (42/53 patients). The most commonly used regimens included proton pump inhibitors (PPI) or VPZ, AMX, and STFX (n=43). The success rate of the VPZ, AMX, and STFX regimens was 89.7% (26/29), whereas that of the PPI, AMX, and STFX regimens was 64.3% (9/14). In the comparison between the success and failure groups, the number of female patients (P=0.001) and AMX sensitivity (P=0.028) were significantly higher in the success group than in the failure group. VPZ use and STFX sensitivity were also more common in the successful group, although the differences were not significant.

VPZ, AMX, and STFX regimens were the most common and effective regimens, with female and AMX-sensitive patients more likely to have successful third-line eradication.