An assessment of the efficacy of first-line Helicobacter pylori-eradication therapy based on clarithromycin susceptibility.

BACKGROUND: In recent years, the efficacy of standard triple therapy comprising proton pump inhibitor, clarithromycin (CAM), and amoxicillin, for the eradication of Helicobacter pylori (H. pylori) infection has reduced owing to the increasing CAM resistance of H. pylori. In this study, we evaluated the effectiveness of first-line H. pylori-eradication therapy on the basis of CAM sensitivity.

METHODS: We enrolled 447 patients who were diagnosed with H. pylori infection from January 2011 to July 2014 and examined the antimicrobial resistance. In total, 260 patients without a history of H. pylori eradication therapy were treated with CAM- or metronidazole (MNZ)-based eradication therapy on the basis of the treatment period and CAM sensitivity of H. pylori. Between January 2011 and June 2013, patients were treated with CAM-based empirical therapy. Between July 2013 and July 2014, patients with CAM-sensitive strains were treated with CAM-based eradication therapy, and those with CAM-resistant strains were treated with MNZ-based therapy.

RESULTS: The overall rate of resistance to CAM was 29.8%. The eradication rates of the empirical therapy and CAM-sensitivity-based therapy were 76.5% and 93.0%, respectively (P<0.001).

CONCLUSIONS: Eradication therapy based on CAM sensitivity was more effective than empirical eradication therapy for the first-line treatment of H. pylori-infected patients.