Helicobacter pylori Antimicrobial Susceptibility Testing-Guided Salvage Therapy in the USA: A Real Life Experience

Dig Dis Sci. 2018 Feb;63(2):437-445. doi: 10.1007/s10620-017-4880-8. Epub 2017 Dec 20.


Background: The current practice guidelines recommend that Helicobacter pylori (H. pylori) culture and antimicrobial susceptibility testing (AST) be considered after patients failed the second course of H. pylori eradication therapy.

Aims: Here we report the real life experience of following this recommendation in the USA.

Methods: We established an in-house H. pylori culture protocol for AST and identified retrospectively patients who previously failed ≥ 2 courses of anti-H. pylori therapy and underwent esophagogastroduodenoscopy with AST at University of Michigan from 2010 to 2017. We determined the rate of H. pylori antibiotic resistance, the success rates of AST-guided tailored therapy, and the risk factors associated with treatment failure.

Results: Forty-seven patients were identified and 34 (72.3%) had successful cultures and AST. The most common antibiotic resistance was to metronidazole (79.4%), followed by clarithromycin (70.6%) and ciprofloxacin (42.9%). None of the patients were resistant to amoxicillin or tetracycline. The overall success rate of AST-guided tailored therapy was low (44.4%, 12/27). In patients infected with metronidazole-resistant H. pylori, bismuth quadruple therapy appears to be superior compared to non-bismuth quadruple therapy (6/8 or 75.0% vs. 3/14 or 21.4%, P = 0.03). High body mass index was significantly associated with tailored therapy failure (OR 1.24, 95% CI 1.00-1.54, P = 0.049).

Conclusions: The success rate of AST-guided salvage therapy in the USA is low particularly in those with high BMI. Bismuth-based therapy appears to be better than non-bismuth-based regimens.

Keywords: Antibiotic resistance; Culture; Helicobacter pylori; Salvage therapy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use*
  • Bismuth / administration & dosage
  • Drug Resistance, Bacterial*
  • Female
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / microbiology*
  • Helicobacter pylori / drug effects*
  • Humans
  • Male
  • Middle Aged
  • Proton Pump Inhibitors / administration & dosage
  • Salvage Therapy
  • Treatment Failure
  • United States


  • Anti-Bacterial Agents
  • Proton Pump Inhibitors
  • Bismuth