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
Research background

Decreased success eradication rates of Helicobacter pylori (H. pylori) have received much attention in recent years, mainly due to the increasing resistance to antibiotics. Hence, the rates and patterns of resistance of H. pylori to antibiotics need to be explored.

Research motivation

Susceptibility-guided therapy based on antibiotic susceptibility test improved H. pylori eradication rates. We evaluated the antibiotic resistance rate of H. pylori, performed precision treatment therapies, and compared the efficacy with empiric treatment therapies. It provided a reference for eradication therapy in regions in the northeast of China.

Research objectives

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

Research methods

We observed antibiotic resistance rates of H. pylori and performed a single-center, clinical trial with the susceptibility-guided eradication regimen.

Research results

Clarithromycin (CLA) and levofloxacin (LFX) resistance rates were 82.6% and 69.7%, respectively. Gastric symptoms and rural residence were independent risk factors for secondary resistance to CLA and LFX, respectively. The overall susceptibility-guided eradication rates calculated using intention-to-treat and per-protocol analyses were 90.6% and 75.5%, respectively, both higher than rates with empiric treatment therapies.

Research conclusions

H. pylori presented high secondary resistance rates to CLA and LFX. For patients with previous treatment failures, treatments guided by antibiotic susceptibility tests showed good eradication efficacy.

Research perspectives

Large-scale, multi-center observed researches in various regions of the province are needed to obtain a more comprehensive profile of antibiotic resistance in Liaoning. It will be necessary to compare the safety, medication adherence and cost-effectiveness of the susceptibility-guided eradication regimen with the empiric eradication regimen in the future.