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

This item is provided by the institution :

Repository :
Annals of Gastroenterology
see the original item page
in the repository's web site and access all digital files if the item*

2018 (EN)
Seven-day genotypic resistance-guided triple Helicobacter pylori eradication therapy can be highly effective (EN)

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

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 highresistance 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 rifabutincontaining triple therapy, the respective eradication rates were 24/27, 20/20, and 2/4 by intentionto-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 Helicobacter pylori, tailored therapy, 23SrRNA, gyrA, triple Helicobacter pylori eradication therapy Ann Gastroenterol 2018; 31 (2): 198-204 (EN)




Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 31, No 2 (2018); 198 (EN)

Copyright (c) 2018 Annals of Gastroenterology (EN)

*Institutions are responsible for keeping their URLs functional (digital file, item page in repository site)