Analysis of Helicobacter pylori Eradication Therapy Based on Drug Susceptibility Testing in Huairou District,...

To assess the feasibility, effectiveness, and safety of susceptibility-guided individualised H. pylori therapy in a region without prior resistance data, using a single-arm prospective observational design.

This prospective study included patients with confirmed H. pylori infection undergoing gastroscopy at Beijing Huairou Hospital (April 2023-May 2024). Molecular testing targeted 23S rRNA mutations (A2142G, A2142C, A2143G) for clarithromycin (CLA) and gyrA mutations (Asn87→Lys/Thr) for levofloxacin (LVX). Patients were assigned to three susceptibility-guided groups: CLA-sensitive, CLA-resistant+LVX-sensitive, and CLA-resistant+LVX-resistant, each receiving 14-day bismuth-containing quadruple therapy. Eradication was confirmed by ¹³C urea breath test 4-8 weeks post-treatment.

Intention-to-treat (ITT) eradication rate was 82.3% (per-protocol [PP]: 87.2%). ITT rates by group: CLA-S 81.8%, CLA-R-LVX-S 83.3%, CLA-R-LVX-R 85.0% (P=0.921). PP rates: 86.3%, 92.1%, 85.0% (P=0.602). No significant differences in compliance or safety (P=0.849; P=0.467).

Susceptibility-guided therapy achieved 85-90% eradication regardless of resistance profile. Although the ITT rate (82.3%) fell short of the 90% guideline threshold, it remains clinically acceptable in a moderate-to-high resistance setting (Huairou: CLA resistance 26.7%, LVX 28.8%, dual 8.6%), supporting the value of susceptibility testing.