Helicobacter pylori Antimicrobial Susceptibility Testing-Guided Salvage Therapy in the USA: A Real Life Experience

• Published in: Digestive diseases and sciences Vol. 63; no. 2; pp. 437 - 445
• Main Authors: Tan, Bei, Yang, Jyh-Chin, Young, Carol L., Bishu, Shrinivas, Owyang, Stephanie Y., El-Zaatari, Mohamad, Zhang, Min, Grasberger, Helmut, Qian, Jia-ming, Kao, John Y.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2018; Springer; Springer Nature B.V
• Subjects: Adult; Amoxicillin; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Biochemistry; Bismuth - administration & dosage; Ciprofloxacin; Drug resistance; Drug Resistance, Bacterial; Female; Gastroenterology; Helicobacter Infections - drug therapy; Helicobacter Infections - microbiology; Helicobacter pylori; Helicobacter pylori - drug effects; Hepatology; Humans; Male; Medicine; Medicine & Public Health; Metronidazole; Middle Aged; Oncology; Original Article; Pathogens; Practice guidelines (Medicine); Proton Pump Inhibitors - administration & dosage; Salvage Therapy; Success; Tetracycline; Tetracyclines; Transplant Surgery; Treatment Failure; United States; United States; United States > US; Culture; Salvage therapy; Antibiotic resistance; Helicobacter pylori
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-017-4880-8

s Background The current practice guidelines recommend that Helicobacter pylori ( H. pylori ) culture and antimicrobial susceptibility testing (AST) be considered after patients failed the second course of H. pylori eradication therapy. Aims Here we report the real life experience of following this recommendation in the USA. Methods We established an in-house H. pylori culture protocol for AST and identified retrospectively patients who previously failed ≥ 2 courses of anti- H. pylori therapy and underwent esophagogastroduodenoscopy with AST at University of Michigan from 2010 to 2017. We determined the rate of H. pylori antibiotic resistance, the success rates of AST-guided tailored therapy, and the risk factors associated with treatment failure. Results Forty-seven patients were identified and 34 (72.3%) had successful cultures and AST. The most common antibiotic resistance was to metronidazole (79.4%), followed by clarithromycin (70.6%) and ciprofloxacin (42.9%). None of the patients were resistant to amoxicillin or tetracycline. The overall success rate of AST-guided tailored therapy was low (44.4%, 12/27). In patients infected with metronidazole-resistant H. pylori , bismuth quadruple therapy appears to be superior compared to non-bismuth quadruple therapy (6/8 or 75.0% vs. 3/14 or 21.4%, P  = 0.03). High body mass index was significantly associated with tailored therapy failure (OR 1.24, 95% CI 1.00–1.54, P  = 0.049). Conclusions The success rate of AST-guided salvage therapy in the USA is low particularly in those with high BMI. Bismuth-based therapy appears to be better than non-bismuth-based regimens.