Effective Eradication Regimen and Duration According to the Clarithromycin Susceptibility of Helicobacter pylori Determined Using Dual Priming Oligonucleotide-Based Multiplex Polymerase Chain Reaction

• Published in: Gut and liver Vol. 17; no. 5; pp. 722 - 730
• Main Authors: Na, Soo-Young, Kim, Byung-Wook, Kim, Min Ji, Choe, Younghee, Kim, Joon Sung
• Format: Journal Article
• Language: English
• Published: Korea (South) Editorial Office of Gut and Liver 01-09-2023; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: Amoxicillin; anti-bacterial agents; Anti-Bacterial Agents - therapeutic use; Bismuth - therapeutic use; Clarithromycin - pharmacology; Clarithromycin - therapeutic use; Drug Therapy, Combination; duration of therapy; Helicobacter Infections - drug therapy; helicobacter pylori; Helicobacter pylori - genetics; Humans; Multiplex Polymerase Chain Reaction - methods; Oligonucleotides; Original; polymerase chain reaction; Retrospective Studies; treatment protocols; 내과학; Polymerase chain reaction; Treatment protocols; Duration of therapy; Helicobacter pylori; Anti-bacterial agents
• ISSN: 1976-2283; 2005-1212; 2005-1212
• DOI: 10.5009/gnl220256

Dual priming oligonucleotide-based multiplex polymerase chain reaction (DPO-PCR) has recently been used for both the detection of
and the identification of
23S ribosomal RNA point mutations that cause clarithromycin resistance. The aim of this study was to investigate the duration of effective standard triple therapy in a clarithromycin susceptible group and of bismuth-based quadruple therapy in a resistant group based on DPO-PCR.
We retrospectively analyzed the electronic medical records of 184 patients who, between September 2019 and December 2020, received eradication therapy following detection of
, and the subsequent identification of the clarithromycin susceptibility of their
using DPO-PCR. Patients were treated with 7- or 14-day standard triple therapy in the clarithromycin susceptible group, whereas 7- or 14-day bismuth-based quadruple therapy in the clarithromycin resistance group.
In the clarithromycin susceptible group, per-protocol analyses showed eradication rates of 87.5% (42/48; 95% confidence interval [CI], 77.1% to 95.8%) for 7-day therapy and 87.2% (41/47; 95% CI, 78.7% to 95.7%) for 14-day therapy (p=0.969). The eradication rates in the clarithromycin resistance group were 91.4% (32/35; 95% CI, 80.0% to 100.0%) for 7-day therapy and 90.3% (28/31; 95% CI, 77.4% to 100.0%) for 14-day therapy (p=0.876). There was no significant difference in the eradication rates, patient compliance, or rate of adverse events between the 7- and 14-day therapies for both groups.
Compared to the 14-day therapy, 7-day eradication therapy is sufficient after DPO-PCR-based clarithromycin susceptibility testing.