Evidence-Based Medicine
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2017; 23(18): 3367-3373
Published online May 14, 2017. doi: 10.3748/wjg.v23.i18.3367
Antimicrobial susceptibility testing before first-line treatment for Helicobacter pylori infection in patients with dual or triple antibiotic resistance
Angel Cosme, Milagrosa Montes, Begoña Ibarra, Esther Tamayo, Horacio Alonso, Usua Mendarte, Jacobo Lizasoan, Marta Herreros-Villanueva, Luis Bujanda
Angel Cosme, Begoña Ibarra, Horacio Alonso, Usua Mendarte, Jacobo Lizasoan, Marta Herreros-Villanueva, Luis Bujanda, Gastroenterology Department, Hospital Universitario Donostia/Instituto Biodonostia, Universidad del País Vasco, Centro de Investigación Biomédica en Red de Enfermedades Hepaticas y Digestivas, 20014 San Sebastián, Spain
Milagrosa Montes, Esther Tamayo, Biomedical Research Center Network for Respiratory Diseases, 20014 San Sebastián, Spain
Milagrosa Montes, Esther Tamayo, Microbiology Department, Hospital Universitario Donostia-Instituto Biodonostia, 20014 San Sebastián, Spain
Marta Herreros-Villanueva, Faculty of Life Sciences, Universidad Isabel I, 09003 Burgos, Spain
Author contributions: Cosme A and Bujanda L designed the study; Cosme A, Montes M, Ibarra B, Tamayo E, Alonso H, Mendarte U, Lizasoan J, Herreros-Villanueva M and Bujanda L coordinated and participated the clinical study; Cosme A, Herreros-Villanueva M and Bujanda L wrote and edited the manuscript.
Conflict-of-interest statement: Attached in a sepatate file as 3 32752 Copyright assignment.
Data sharing statement: All study participants, or their legal guardian, provided informed written consent. All the data from participants are here anonymized and there is not risk of identification.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Luis Bujanda, Gastroenterology Department, Hospital Universitario Donostia/Instituto Biodonostia, Universidad del País Vasco, Centro de Investigación Biomédica en Red de Enfermedades Hepaticas y Digestivas, Paseo Dr. Beguiristain s/n, 20014 San Sebastián, Spain. medik@telefonica.net
Telephone: +34-943-007173 Fax: +34-943-007065
Received: January 21, 2017
Peer-review started: January 22, 2017
First decision: February 10, 2017
Revised: February 19, 2017
Accepted: March 15, 2017
Article in press: March 15, 2017
Published online: May 14, 2017
Abstract
AIM

To evaluate the efficacy of antimicrobial susceptibility-guided therapy before first-line treatment for infection in patients with dual or triple antibiotic resistance.

METHODS

A total of 1034 patients infected by Helicobacter pylori (H. pylori) during 2013-2014 were tested for antimicrobial susceptibility. 157 of 1034 (15%) patients showed resistance to two (127/1034; 12%) and to three (30/1034; 3%) antibiotics. Sixty-eight patients with dual H. pylori-resistance (clarithromycin, metronidazole or levofloxacin) were treated for 10 d with triple therapies: OAL (omeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d., and levofloxacin 500 mg b.i.d.) 43 cases, OAM (omeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d., and metronidazole 500 mg b.i.d.) 12 cases and OAC (omeprazole 20 mg b.id., amoxicillin 1 g b.i.d., and clarithromycin 500 mg b.i.d.) 13 cases based on the antimicrobial susceptibility testing. Twelve patients showed triple H. pylori-resistance (clarithromycin, metronidazole and levofloxacin) and received for 10 d triple therapy with OAR (omeprazole 20 mg b.id., amoxicillin 1 g b.i.d., and rifabutin 150 mg b.i.d.). Eradication was confirmed by 13C-urea breath test. Adverse effects and compliance were assessed by a questionnaire.

RESULTS

Intention-to-treat eradication rates were: OAL (97.6%), OAM (91.6%), OAC (92.3%) and OAR (58.3%). Cure rate was significantly higher in naïve patients treated with OAR-10 compared to patients who had two or three previous treatment failures (83% vs 33%). Adverse events rates for OAL, OAM, OAC and OAR were 22%, 25%, 23% and 17%, respectively, all of them mild-moderate.

CONCLUSION

Antimicrobial susceptibility-guided triple therapies during 10 d for first-line treatment leads to an eradication rate superior to 90% in patients with dual antibiotic H. pylori resistance.

Keywords: Helicobacter pylori, Resistance, Eradication rate, Antimicrobial susceptibility, Therapies

Core tip: This study evaluated the efficacy of antimicrobial susceptibility-guided therapy: proton-pump inhibitor and two or three antibiotics for ten days before first-line treatment in patients with dual or triple Helicobacter pylori resistance to clarithromycin, metronidazole and/or levofloxacin. Intention to treat analysis demonstrates that eradication rates in patients with dual Helicobacter pylori resistance are high (around 95%). Cure rate was significantly higher in naive patients with dual resistance compared to those with triple resistance (95% vs 83%).