Tailored eradication therapy based on fecal Helicobacter pylori clarithromycin sensitivities

J Gastroenterol Hepatol. 2008 Dec;23 Suppl 2:S171-4. doi: 10.1111/j.1440-1746.2008.05408.x.

Abstract

Background and aim: Helicobacter pylori (H. pylori) eradication rates using the PPI/AC regimen (proton pump inhibitor + amoxicillin + clarithromycin) are declining. We trialed tailoring eradication regimens according to clarithromycin (CAM) susceptibility.

Methods: The subjects were 70 H. pylori positive adults. They were randomly allocated to a tailored group and a control group. In the tailored group, subjects with CAM-sensitive strains were given PPI/AC eradication therapy, and those with CAM-resistant strains were given PPI/AM (metronidazole instead of clarithromycin) therapy. The control group were all given PPI/AC therapy. CAM sensitivity was measured by collecting fecal specimens, and extracting the DNA. The 23S rRNA domain, associated with CAM susceptibility in H. pylori, was amplified using a nested polymerase chain reaction (PCR), and DNA sequencing was used to detect point mutations at A2143G and A2144G.

Results: Eradication rates were 94.3% in the tailored group and 71.4% in the control group. In particular, the eradication rate was 100% for CAM-resistant strains in the tailored group.

Conclusions: In Japan, where CAM-resistant H. pylori strains are expected to continue to increase, tailored eradication therapy according to CAM sensitivity will be of benefit.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Amoxicillin / therapeutic use
  • Anti-Bacterial Agents / therapeutic use*
  • Aryl Hydrocarbon Hydroxylases / genetics
  • Clarithromycin / therapeutic use*
  • Cytochrome P-450 CYP2C19
  • DNA, Bacterial / isolation & purification
  • Drug Resistance, Bacterial* / genetics
  • Drug Therapy, Combination
  • Feces / microbiology*
  • Female
  • Genotype
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / microbiology
  • Helicobacter pylori / drug effects*
  • Helicobacter pylori / genetics
  • Helicobacter pylori / growth & development
  • Humans
  • Male
  • Metronidazole / therapeutic use
  • Microbial Sensitivity Tests
  • Middle Aged
  • Patient Selection
  • Point Mutation
  • Proton Pump Inhibitors / therapeutic use*
  • Ribotyping
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • DNA, Bacterial
  • Proton Pump Inhibitors
  • Metronidazole
  • Amoxicillin
  • Aryl Hydrocarbon Hydroxylases
  • CYP2C19 protein, human
  • Cytochrome P-450 CYP2C19
  • Clarithromycin