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Tailored eradication therapy based on fecal Helicobacter pylori clarithromycin sensitivities.

Author(s): Kawai T, Yamagishi T, Yagi K, Kataoka M, Kawakami K, Sofuni A, Itoi T, Sakai Y, Moriyasu F, Osaka Y, Takagi Y, Aoki T, Rimbara E, Noguchi N, Sasatsu M

Affiliation(s): Endoscopy Center, Tokyo Medical University, Tokyo, Japan. t-kawai@tokyo-med.ac.jp

Publication date & source: 2008-12, J Gastroenterol Hepatol., 23 Suppl 2:S171-4.

Publication type: Randomized Controlled Trial

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.

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