Efficacy of Tailored Helicobacter pylori Eradication Treatment Based on Clarithromycin Susceptibility and Maintenance of Acid Secretion

Background Insufficient acid inhibition during Helicobacter pylori eradication treatment and bacterial resistance to antibiotics often causes eradication failure. Four times daily dosing (q.i.d.) of a proton‐pump inhibitor ( PPI ) achieves potent acid inhibition, suggesting its potential usefulness as a regimen for eradicating H. pylori infection. Therefore, a tailored eradication regimen based on antibiotic susceptibility and maintenance of acid inhibition should have a high success rate. We investigated the efficacy of such treatment based on clarithromycin ( CAM ) susceptibility. Methods Using 153 H. pylori ‐positive Japanese patients, we investigated the efficacy of tailored eradication strategy: (1) Patients infected with CAM ‐sensitive H. pylori were treated with a PPI (rabeprazole 10 mg q.i.d.), amoxicillin 500 mg q.i.d., and CAM 200 mg b.i.d. (n = 89), and (2) patients infected with CAM ‐resistant were given the same doses of rabeprazole and amoxicillin and metronidazole 250 mg b.i.d. (n = 64) for 1 week. Results In the tailored regimen group, the overall eradication rate was 96.7% (95% CI : 92.5–98.9%, 148/153) in the intention‐to‐treat ( ITT ) analysis and 97.4% (93.4–99.3%, 148/152) in the PP analysis. The eradication rates for the CAM ‐ and metronidazole‐based treatments were similar (95.5% and 98.4%, respectively, p  = .400). The tailored treatment achieved a high eradication rate in CYP 2C19 rapid metabolizers who were a resistance genotype for PPI treatment (94.3% (86.0–98.4%, 66/70)). Discussion A tailored H. pylori eradication regimen based on CAM susceptibility and maintaining acid secretion (rabeprazole 10 mg q.i.d.) is useful because it can achieve an eradication rate exceeding 95%, irrespective of eradication history, thus overcoming differences among CYP 2C19 genotypes.