Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2024; 30(2): 184-195
Published online Jan 14, 2024. doi: 10.3748/wjg.v30.i2.184
Success of susceptibility-guided eradication of Helicobacter pylori in a region with high secondary clarithromycin and levofloxacin resistance rates
Yan-Meng Wang, Mo-Ye Chen, Jing Chen, Xin-He Zhang, Yan Feng, Yu-Xi Han, Yi-Ling Li
Yan-Meng Wang, Mo-Ye Chen, Xin-He Zhang, Yan Feng, Yu-Xi Han, Yi-Ling Li, Department of Gastroenterology, The First Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
Jing Chen, Key Laboratory of Cancer Etiology and Prevention in Liaoning Education Department, The First Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
Author contributions: Li YL conceived the study and carried out the experiments; Wang YM drafted the manuscript and completed data analysis; Chen MY suggested amendments to the manuscript; Chen J and Zhang XH provided assistance with data analysis; Feng Y and Han YX contributed to data collection; all authors approved the final version of the article.
Institutional review board statement: The study was reviewed and approved by the the Human Ethics Review Committee of the First Affiliated Hospital of China Medical University (Approval No. 2021325).
Informed consent statement: All study participants provided informed written consent prior to study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Ling Li, MD, Chief Physician, Professor, Department of Gastroenterology, The First Affiliated Hospital of China Medical University, No. 92 North Second Road, Shenyang 110000, Liaoning Province, China. lyl-72@163.com
Received: October 30, 2023
Peer-review started: October 30, 2023
First decision: November 29, 2023
Revised: December 12, 2023
Accepted: December 28, 2023
Article in press: December 28, 2023
Published online: January 14, 2024

Resistance to clarithromycin (CLA) and levofloxacin (LFX) of Helicobacter pylori (H. pylori) is increasing in severity, and successful eradication is essential. Presently, the eradication success rate has greatly declined, leaving a large number of patients with previous treatment histories.


To investigate secondary resistance rates, explore risk factors for antibiotic resistance, and assess the efficacy of susceptibility-guided therapy.


We recruited 154 subjects positive for Urea Breath Test who attended The First Affiliated Hospital of China Medical University between July 2022 and April 2023. Participants underwent a string test after an overnight fast. The gastric juice was obtained and transferred to vials containing storage solution. Subsequently, DNA extraction and the specific DNA amplification were performed using quantitative polymerase chain reaction (qPCR). Demographic information was also analyzed as part of the study. Based on these results, the participants were administered susceptibility-guided treatment. Efficacy was compared with that of the empiric treatment group.


A total of 132 individuals tested positive for the H. pylori ureA gene by qPCR technique. CLA resistance rate reached a high level of 82.6% (n = 109), LFX resistance rate was 69.7% (n = 92) and dual resistance was 62.1% (n = 82). Gastric symptoms [odds ratio (OR) = 2.782; 95% confidence interval (95%CI): 1.076-7.194; P = 0.035] and rural residence (OR = 5.152; 95%CI: 1.407-18.861; P = 0.013) were independent risk factors for secondary resistance to CLA and LFX, respectively. A total of 102 and 100 individuals received susceptibility-guided therapies and empiric treatment, respectively. The antibiotic susceptibility-guided treatment and empiric treatment groups achieved successful eradication rates of 75.5% (77/102) and 59.0% (59/411) by the intention-to-treat (ITT) analysis and 90.6% (77/85) and 70.2% (59/84) by the per-protocol (PP) analysis, respectively. The eradication rates of these two treatment strategies were significantly different in both ITT (P = 0.001) and PP (P = 0.012) analyses.


H. pylori presented high secondary resistance rates to CLA and LFX. For patients with previous treatment failures, treatments should be guided by antibiotic susceptibility tests or regional antibiotic resistance profile.

Keywords: Helicobacter pylori, Antibiotic resistance, Clarithromycin, Levofloxacin, String-test, Susceptibility-guided therapy, Eradication rate

Core Tip: Decreased success eradication rates of Helicobacter pylori (H. pylori) have received much attention in recent years, mainly due to the increasing resistance to antibiotics. Focus has begun to be placed on the efficacy of antibiotic susceptibility-guided eradication. This study revealed that the secondary resistance rate of H. pylori to clarithromycin and levofloxacin in Province Liaoning, was higher than the national average. Antibiotic susceptibility-guided eradication therapy is more effective than empiric treatment. It provided a reference for eradication therapy in regions in the northeast of China.