51. Optimizing the MIC breakpoints of amoxicillin and tetracycline for antibiotic selection in the rescue therapy of H. pylori with bismuth quadruple regimen
- Author
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Hsin Yu Kuo, Meng Ying Lin, Chung Tai Wu, Wei Lun Chang, Hsiu Chi Cheng, Bor Shyang Sheu, Hsiao Bai Yang, Ming Tsung Hsieh, and Yu Chin Tsai
- Subjects
Adult ,Male ,medicine.medical_specialty ,Tetracycline ,medicine.drug_class ,Antibiotics ,Microbial Sensitivity Tests ,030226 pharmacology & pharmacy ,Gastroenterology ,Helicobacter Infections ,03 medical and health sciences ,0302 clinical medicine ,Levofloxacin ,Clarithromycin ,Internal medicine ,Drug Resistance, Multiple, Bacterial ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Aged ,Pharmacology ,biology ,Helicobacter pylori ,business.industry ,Amoxicillin ,General Medicine ,Middle Aged ,biology.organism_classification ,Metronidazole ,Regimen ,Drug Therapy, Combination ,Female ,business ,Bismuth ,medicine.drug - Abstract
H. pylori with triple-drug resistance (TR) to clarithromycin, metronidazole, and levofloxacin limits the success of rescue therapy. We aimed to identify the optimal breakpoints of antibiotic minimal inhibitory concentration (MIC) to predict the success of rescue therapy for TR H. pylori infection. We consecutively enrolled 430 patients with at least one course of failed H. pylori eradications to receive an H. pylori culture for antibiotic MIC test. Seventy-three (17%) had TR H. pylori infection (MIC of clarithromycin > 0.5, levofloxacin > 1, and metronidazole > 8 mg/L, respectively). Sixty-nine cases with TR H. pylori infection received rescue therapy with either ATBP (amoxicillin, tetracycline, bismuth, and PPI) or MTBP (metronidazole, tetracycline, bismuth and PPI) for 7–14 days. Fourteen patients with positive 13C-urea breath test after the first rescue therapy were retreated with a crossover second rescue therapy. The MTBP regimen had higher eradication success than the ATBP regimen as the first rescue therapy for TR H. pylori (intent-to-treat (ITT) analysis, 70.3 vs. 46.9%, p = 0.048; per protocol (PP) analysis, 78.8% vs. 51.7%, p = 0.025). For MTBP regimen, tetracycline MIC ≤ 0.094 mg/L (p
- Published
- 2020