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. 2018 Mar-Apr;31(2):198-204.
doi: 10.20524/aog.2017.0219. Epub 2017 Nov 30.

Seven-day genotypic resistance-guided triple Helicobacter pylori eradication therapy can be highly effective

Vasilios Papastergiou  1 , Nicoletta Mathou  1 , Sophia Licousi  2 , Aikaterini Evgenidi  1 , Konstantina D Paraskeva  1 , Athanasios Giannakopoulos  1 , Pinelopi-Zoi Stavrou  1 , Evangelia Platsouka  2 , John A Karagiannis  1
Affiliations

Seven-day genotypic resistance-guided triple Helicobacter pylori eradication therapy can be highly effective

Vasilios Papastergiou et al. Ann Gastroenterol. 2018 Mar-Apr.

Abstract

Background: The efficacy and applicability of molecular testing to guide the selection of antibiotics in triple Helicobacter pylori (H. pylori) eradication regimens have not been reported. We tested a 7-day, genotypic resistance-guided triple H. pylori eradication therapy in a high-resistance setting.

Methods: Consecutive dyspeptic patients with H. pylori infection were prospectively enrolled. Genotypic resistances to clarithromycin (23SrRNA mutations) and fluoroquinolones (gyrA mutations) were determined from gastric biopsy specimens using a commercially available molecular assay (GenoTypeâ HelicoDR). A tailored genotypic resistance-guided 7-day triple therapy comprised esomeprazole, amoxicillin, and either clarithromycin (wild-type 23SrRNA), levofloxacin (23SrRNA mutated/wild-type gyrA) or rifabutin (both 23SrRNA/gyrA mutated). H. pylori eradication was confirmed by 13C-urea breath test.

Results: Of 148 subjects screened, 51 patients were enrolled (male/female: 27/24, mean age: 50.7±11.4 years, treatment-naïve/-experienced: 32/19). The molecular kit was easily implemented, allowing for rapid (within 24 h) and relatively inexpensive determination of H. pylori resistance (clarithromycin: 47.1%, fluoroquinolones: 15.7%, dual clarithromycin/fluoroquinolones: 7.8%). For patients who received clarithromycin-, levofloxacin- and rifabutin-containing triple therapy, the respective eradication rates were 24/27, 20/20, and 2/4 by intention-to-treat (ITT); and 24/24, 19/19 and 2/3 by per-protocol (PP) analysis. Overall eradication rates were 90.2% (95% confidence interval [CI] 77.8-96.3%) by ITT and 97.8% (95%CI 87-99.8%) by PP analysis, showing no significant difference between treatment-naïve and -experienced patients (ITT: 87.5% vs. 94.7%, P=0.64; PP: 96.4% vs. 100%, respectively, P=1.00).

Conclusions: Regardless of prior treatment history, a genotypic resistance-guided 7-day triple therapy, based on a simple molecular assay, achieved a high H. pylori eradication rate.

Keywords: 23SrRNA; Helicobacter pylori; gyrA; tailored therapy; triple Helicobacter pylori eradication therapy.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Flow chart of the study Wt, wild type; mut, mutated; CAM, clarithromycin; LEV, levofloxacin; RIF, rifabutin; ITT, intention to treat; PP, per protocol.
See this image and copyright information in PMC

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