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Purpose: This study evaluates and compares the eradication rates of Helicobacter pylori (H. pylori) achieved through susceptibility-guided therapy (SGT) based on resistance genotyping and empirical therapy (ET). Patients and Methods: A retrospective study was conducted at Beijing Chaoyang Hospital (2021– 2023) on patients with H. pylori infection receiving initial eradication therapy. Resistance genotypes for clarithromycin and levofloxacin were identified using fluorescent PCR of gastric biopsy samples. Patients underwent a 14-day bismuth-containing quadruple therapy (BQT) and were evaluated via the C13 urea breath test (UBT). Based on genotyping or clinical judgment, 550 patients were assigned to SGT (n = 125) or ET (n = 425). The SGT group received personalized treatment based on genotype testing results, avoiding the use of antibiotics to which the bacteria were resistant. The ET group received the standard bismuth-containing quadruple therapy (BQT). Additionally, 29 ET patients underwent follow-up genotypic testing and eradication rates were analyzed retrospectively. Results: SGT achieved higher eradication rates than ET (ITT: 94.4% vs 86.1%, P = 0.012; PP: 95.2% vs 87.6%, P = 0.016). In levofloxacin-resistant strains, SGT showed significantly higher eradication rates in the PP analysis (95.7% vs 50.0%, P = 0.049). Conclusion: SGT exhibited remarkably superior eradication rates, notably in levofloxacin-resistant strains, proposing a compelling alternative for the treatment of H. pylori, particularly in instances of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Background: As the reduced eradication rate of Helicobacter pylori (H. pylori), we introduced string‐test and quantitative PCR (qPCR) for susceptibility‐guided therapy innovatively. The practicality of the string test was evaluated. Methods: It was an open‐label, non‐randomized, parallel, single‐center study, in which subjects tested by 13C‐ urea breath test (UBT) and string‐qPCR were enrolled. Based on the results of string‐qPCR, we calculated clarithromycin and levofloxacin resistance rates and gave 13C‐UBT positive patients 14 days susceptibility‐guided bismuth quadruple therapy. In the empirical therapy group, we retrospectively analyzed the treatment results of 13C‐UBT positive patients also treated with bismuth quadruple at Shenzhen Luohu People's Hospital from January 2021 to May 2022. The eradication rate was compared between susceptibility‐guided therapy and empirical therapy groups. Results: The diagnosis of H. pylori infection using the string‐qPCR had an overall concordance rate of 95.9% with the 13C‐UBT results. Based on the results of string‐qPCR, the clarithromycin and levofloxacin resistance rates were 26.1% and 31.8%, respectively. The patients who were given 14 days susceptibility‐guided bismuth‐based quadruple therapy achieved a high H. pylori eradication rate of 91.8%. Retrospective analysis of patient treatment data from January 2021 to May 2022 available in the hospital database revealed an overall success rate of 82.3% for those who received empirical bismuth‐based quadruple therapies, which is marginally significantly lower than that of the string‐qPCR susceptibility‐guided group (p = 0.084). Conclusion: The high treatment success rate of 91.8% indicates that the string‐qPCR test is a valuable and feasible approach for clinical practice to help improve H. pylori treatment success rate. [ABSTRACT FROM AUTHOR]

Background and Aim: Most consensuses recommend culture‐guided therapy as third‐line Helicobacter pylori treatment. This study aimed to investigate the efficacies of culture‐guided therapy and empirical therapy with high‐dose proton pump inhibitor (PPI) in the H. pylori third‐line treatment. Methods: Between August 2012 and October 2021, H. pylori‐infected patients with at least two failed eradication attempts received anti‐H. pylori therapy according to the results of antimicrobial sensitivity tests plus high‐dose rabeprazole and/or bismuth. They were categorized into three groups: patients who had positive results of culture with equal to or more than three susceptible antibiotics were treated by culture‐guided non‐bismuth quadruple therapy, patients who had positive results of culture with one or two susceptible antibiotics were treated by culture‐guided bismuth‐containing therapy, and patients who had a negative result of culture were treated by an empirical therapy with high‐dose rabeprazole plus amoxicillin, tetracycline and levofloxacin. A post‐treatment assessment was conducted at week 8. Results: We recruited 126 patients. The eradication rates of culture‐guided non‐bismuth quadruple therapy (n = 50), culture‐guided bismuth‐containing therapy (n = 46) and empirical therapy (n = 30) were 84.0%, 87.0%, and 66.7% (95% confidence interval: 73.8–94.2%, 77.3–96.7%, and 49.8–83.6%), respectively. Overall, culture‐guided therapy achieved a higher eradication rate than empirical therapy (85.4% vs 66.7%; 95% confidence interval, 0.4% to 37.0%, P = 0.022). Conclusions: Culture‐guided therapy with high‐dose PPI achieves a higher eradication rate than empirical therapy with high‐dose PPI in the third‐line treatment of H. pylori infection. The eradication rate of rescue therapy with bismuth plus two susceptible antibiotics is not inferior to that with three susceptible antibiotics. [ABSTRACT FROM AUTHOR]

Background: The increasing antimicrobial resistance of Helicobacter pylori (H. pylori) has resulted in a fall in cure rates. We aimed to assess the effectiveness of first-line susceptibility-guided therapy and furazolidone-based quadruple therapy for H. pylori-infected patients. Methods: Subjects with H. pylori-infection were randomly assigned to either 10-day susceptibility-guided treatment or empiric treatment in a 2:1 ratio. Susceptibility-guided therapy was based on susceptibility to clarithromycin, and patients with susceptible strains received clarithromycin 500 mg twice daily and otherwise minocycline 100 mg twice a day was administered. Patients in the empiric therapy group was treated with furazolidone 100 mg twice a day. During treatment, all patients were given esomeprazole 20 mg twice daily, colloidal bismuth pectin 200 mg twice daily, and amoxicillin 1 g twice daily. Results: A total of 248 patients were screened and 201 were finally included. Empiric and susceptibility-guided regimens were both successful with perprotocol eradication rates of 90.5% (57/63) vs. 88.5% (108/122) (p = 0.685) and intent-to-treat eradication rates of 85.1% (57/67) vs. 80.6% (108/134) (p = 0.435). No significant difference in eradication rates were observed among the furazolidone group, clarithromycin group and minocycline group. Conclusion: Both susceptibility-guided therapy and quadruple therapy containing furazolidone can achieve good eradication rates. For population with a high rate of resistance, quadruple therapy containing furazolidone and bismuth may be a more practical choice for first-line treatment. [ABSTRACT FROM AUTHOR]

Background and Aim: Not all the susceptibility‐guided therapies for Helicobacter pylori (H. pylori) infection achieve excellent eradication rates. The aim of this study was to perform a systematic review and meta‐analysis to identify the optimal regimen for H. pylori treatment based on antibiotic susceptibility. Methods: A systematic search was performed in multiple databases. Studies reporting eradication rates of H. pylori with susceptibility‐guided therapies were selected. Meta‐analysis was conducted to calculate the pooled eradication rate among the treatment regimens. Results: Forty‐eight eligible studies with 101 susceptibility‐guided treatment arms were included. The overall eradication rate in patients harboring susceptible strains was 95.0% (95% CI, 94.1–95.9%), but only 63.4% of treatment arms (64/101) achieved good eradication rates (≥ 90%). Pooled eradication rates in patients with susceptible strains were: 93.4% (95% CI, 92.0–94.8%) for clarithromycin, 99.0% (95% CI, 98.1–100%) for nitroimidazoles and 95.4% (95% CI, 93.6–97.2%) for fluoroquinolones. Among the arms using a triple therapy, 66.7% (28/42) using clarithromycin, 84.2% (16/19) using nitroimidazoles and 70.8% (17/24) using fluoroquinolones achieved good (≥ 90%) eradication rates. Of 13 arms using sequential therapy, ≥ 90% eradication was achieved in 14.3% (1/7) using clarithromycin, 25.0% (1/4) using nitroimidazoles and both arms (2/2) using fluoroquinolones. Conclusions: Susceptibility testing alone seemed insufficient to reliably attain high H. pylori cure rates. The eradication rate in patients with nitroimidazoles susceptible strains was higher than those of fluoroquinolones and clarithromycin. [ABSTRACT FROM AUTHOR]

BackgroundThe increased antibiotic resistance of Helicobacter pylori (H. pylori) has led to the decreased efficacy of H. pylori regimens.AimTo evaluate the efficacy, safety, and compliance of susceptibility-guided therapy (SGT) vs. bismuth-containing quadruple therapy (BQT) as the first-line treatment for H. pylori infection.Materials and MethodsThis meta-analysis was performed in accordance with the PRISMA 2009 guidelines. A systematic search in PubMed, Embase, and Cochrane databases was conducted using the combination of “H. pylori or H. pylori or Hp,” “bismuth quadruple,” and “tailored eradication OR tailored therapy OR susceptibility-guided therapy OR personalized therapy OR antibiotic susceptibility testing.”ResultsFive studies with 2,110 H. pylori-infected patients were enrolled. The pooled eradication rates of SGT and BQT were 86 vs. 78% (p < 0.05) and 92 vs. 86% (p > 0.05) by intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. SGT has a significantly superior efficacy than BQT [pooled risk ratio (RR) = 1.14, p < 0.05] in a subgroup of cultures with the susceptibility test. The pooled side effect rate was 20% in SGT and 22% in BQT, which showed no significant difference (p > 0.05). The compliances of SGT and BQT were 95 and 92%, respectively.ConclusionCompared with BQT, SGT showed a higher efficacy and similar safety as the first-line treatment of H. pylori infection in areas with high antibiotic resistance. The decision-making of first-line regimens for H. pylori infection should depend on the availability and cost-effectiveness of susceptibility tests and bismuth in local areas.

Helicobacter pylori continues to present therapeutic challenges for clinicians across the world. This review article aims to consolidate current knowledge of H. pylori infection with a particular emphasis on treatment strategy and summarizes important studies regarding H. pylori therapy published from April 2020 to March 2021. Proton pump inhibitor (PPI)-amoxicillin dual therapy can be considered when antimicrobial susceptibility testing cannot be performed. Triple therapy for 14 days may be sufficient in some regions with low clarithromycin resistance. Less expensive sequential and hybrid therapy were more successful and as well tolerated as the currently recommended concomitant therapy and should be favored as non-bismuth quadruple regimens. Bismuth quadruple therapy with tetracycline and modified bismuth quadruple therapy with amoxicillin were highly effective and safe in H. pylori eradication and should be kept in mind as H. pylori first-line therapy in regions with high resistance to clarithromycin. These therapies also have a good performance as second-line and third-line regimens and revealed a satisfactory eradication rate as rescue therapy. In patients allergic to penicillin, quadruple regimen with PPI + bismuth + tetracycline and metronidazole seems to be a good option. Rifabutin and nitazoxanide-based regimens are safe and effective as a salvage therapy in patients who have failed prior treatments. Superiority of vonoprazan in eradicating H. pylori was observed, notably on the resistant strains. The drug-resistance phenomenon in H. pylori underlines the need for novel strategies to improve the eradication rate, especially susceptibility-guided therapy.

Background: Helicobacter pylori (H pylori) treatment remains a challenge for penicillin‐allergic patients. Aim: To evaluate the efficacy and tolerability of susceptibility‐guided first‐line and rescue treatment in H pylori‐infected penicillin‐allergic patients. Methods: Consecutive H pylori‐infected patients with penicillin allergy received a 14‐day triple or quadruple therapy based on susceptibility to clarithromycin, levofloxacin, and metronidazole. All received esomeprazole 20 mg twice a day. Metronidazole‐susceptible infections received metronidazole plus clarithromycin or levofloxacin triple therapy if susceptible. Clarithromycin‐ and levofloxacin‐resistant infections received metronidazole plus tetracycline triple therapy. Metronidazole‐resistant infections received a bismuth—high‐dose metronidazole plus clarithromycin or levofloxacin quadruple therapy. Triple‐resistant infections received classical bismuth quadruple therapy with high‐dose metronidazole. Antimicrobial susceptibility was assessed using the E test method. Results: 112 patients were entered (34.8% men, average 47.1 years). Infections in 83.8% (31/37) of treatment‐naive subjects and 12.0% (9/75) (P <.001) receiving rescue treatment were susceptible to at least one of the three tested antibiotics. Overall, susceptibility‐guided therapy achieved eradication rates of 92.9% (104/112, 95% CI 88.1%‐97.7%) by intent‐to‐treat analysis and 99% (100/101, 95% CI 97.1%‐100%) by per‐protocol analysis. All regimens achieved eradication rates greater than 90% (P =.327) in the PP populations. Adverse events were relatively frequent; however, compliance remained high. Conclusion: Susceptibility‐guided therapy proved highly effective for penicillin‐allergic patients. When available and proven locally effective, the alternative was empiric classical bismuth quadruple therapy. This trial is registered with ClinicalTrials.gov as NCT03708848. [ABSTRACT FROM AUTHOR]

Background: Resistance to clarithromycin (CLA) and levofloxacin (LFX) of Helicobacter pylori (H. pylori) is increasing in severity, and successful eradication is essential. Presently, the eradication success rate has greatly declined, leaving a large number of patients with previous treatment histories., Aim: To investigate secondary resistance rates, explore risk factors for antibiotic resistance, and assess the efficacy of susceptibility-guided therapy., Methods: We recruited 154 subjects positive for Urea Breath Test who attended The First Affiliated Hospital of China Medical University between July 2022 and April 2023. Participants underwent a string test after an overnight fast. The gastric juice was obtained and transferred to vials containing storage solution. Subsequently, DNA extraction and the specific DNA amplification were performed using quantitative polymerase chain reaction (qPCR). Demographic information was also analyzed as part of the study. Based on these results, the participants were administered susceptibility-guided treatment. Efficacy was compared with that of the empiric treatment group., Results: A total of 132 individuals tested positive for the H. pylori ureA gene by qPCR technique. CLA resistance rate reached a high level of 82.6% ( n = 109), LFX resistance rate was 69.7% ( n = 92) and dual resistance was 62.1% ( n = 82). Gastric symptoms [odds ratio (OR) = 2.782; 95% confidence interval (95%CI): 1.076-7.194; P = 0.035] and rural residence (OR = 5.152; 95%CI: 1.407-18.861; P = 0.013) were independent risk factors for secondary resistance to CLA and LFX, respectively. A total of 102 and 100 individuals received susceptibility-guided therapies and empiric treatment, respectively. The antibiotic susceptibility-guided treatment and empiric treatment groups achieved successful eradication rates of 75.5% (77/102) and 59.0% (59/411) by the intention-to-treat (ITT) analysis and 90.6% (77/85) and 70.2% (59/84) by the per-protocol (PP) analysis, respectively. The eradication rates of these two treatment strategies were significantly different in both ITT ( P = 0.001) and PP ( P = 0.012) analyses., Conclusion: H. pylori presented high secondary resistance rates to CLA and LFX. For patients with previous treatment failures, treatments should be guided by antibiotic susceptibility tests or regional antibiotic resistance profile., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflict of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Empirical therapy of Helicobacter pylori frequently results in treatment failure due to unrecognized antimicrobial resistance. The aim of this study was to investigate the effectiveness of susceptibility-guided therapy for rescue treatment of H. pylori infection in China. Methods: This was a prospective study of consecutive 200 patients infected with H. pylori with one or more treatment failures. The therapy chosen was susceptibility based using the most effective, best-tolerated regimens first and a locally proven, reliably effective regimen for multidrug-resistant infections. All patients received 14-day triple therapy, i.e. esomeprazole 20 mg and amoxicillin 1 g twice a day plus clarithromycin 500 mg twice a day, metronidazole 400 mg twice a day, or levofloxacin 500 mg daily, or, for multidrug-resistant infections, amoxicillin-containing bismuth quadruple therapy with esomeprazole 20 mg twice a day, bismuth 220 mg twice a day, amoxicillin 1 g three times a day, and metronidazole 400 mg four times a day. Antibiotic resistance was determined by agar dilution. Results: The eradication rate of susceptibility-guided therapy overall was 94.5% (189/200, 95% confidence interval: 90.4–97.2%). Around 28% (56/200) of patients carried strains susceptible to one of the tested antibiotics and were prescribed the triple therapy. A total of 144 multidrug-resistant patients received bismuth quadruple therapy. The eradication rates were all greater than 90%, i.e. 91.7% (11/12), 92.3% (12/13), and 93.5% (29/31) in those who received clarithromycin, metronidazole, and levofloxacin-containing triple therapy and 95.1% (137/144) for the bismuth quadruple therapy. There were no differences in eradication rates between the subgroups. Conclusions: Although susceptibility-guided therapy proved high efficacious despite the high proportion of multidrug-resistant strains, the strategy suggested the best approach for this population would be empirical amoxicillin-containing bismuth quadruple therapy. ClinicalTrials.gov identifier: NCT03413020. [ABSTRACT FROM AUTHOR]