Premium
Tailored eradication therapy based on fecal Helicobacter pylori clarithromycin sensitivities
Author(s) -
Kawai Takashi,
Yamagishi Tetsuya,
Yagi Kenji,
Kataoka Mikinori,
Kawakami Kohei,
Sofuni Atsushi,
Itoi Takao,
Sakai Yoshihiro,
Moriyasu Fuminori,
Osaka Yoshiaki,
Takagi Yu,
Aoki Tatsuya,
Rimbara Emiko,
Noguchi Norihisa,
Sasatsu Masanori
Publication year - 2008
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2008.05408.x
Subject(s) - clarithromycin , helicobacter pylori , metronidazole , medicine , amoxicillin , regimen , gastroenterology , antibiotics , microbiology and biotechnology , biology
Background and Aim: Helicobacter pylori ( H. pylori ) eradication rates using the PPI/AC regimen (proton pump inhibitor + amoxicillin + clarithromycin) are declining. We trialed tailoring eradication regimens according to clarithromycin (CAM) susceptibility. Methods: The subjects were 70 H. pylori positive adults. They were randomly allocated to a tailored group and a control group. In the tailored group, subjects with CAM‐sensitive strains were given PPI/AC eradication therapy, and those with CAM‐resistant strains were given PPI/AM (metronidazole instead of clarithromycin) therapy. The control group were all given PPI/AC therapy. CAM sensitivity was measured by collecting fecal specimens, and extracting the DNA. The 23S rRNA domain, associated with CAM susceptibility in H. pylori , was amplified using a nested polymerase chain reaction (PCR), and DNA sequencing was used to detect point mutations at A2143G and A2144G. Results: Eradication rates were 94.3% in the tailored group and 71.4% in the control group. In particular, the eradication rate was 100% for CAM‐resistant strains in the tailored group. Conclusions: In Japan, where CAM‐resistant H. pylori strains are expected to continue to increase, tailored eradication therapy according to CAM sensitivity will be of benefit.