PMID- 34382277
OWN - NLM
STAT- MEDLINE
DCOM- 20211015
LR  - 20211015
IS  - 1523-5378 (Electronic)
IS  - 1083-4389 (Linking)
VI  - 26
IP  - 5
DP  - 2021 Oct
TI  - Favorable outcomes of rescue second- or third-line culture-based Helicobacter 
      pylori eradication treatment in areas of high antimicrobial resistance.
PG  - e12844
LID - 10.1111/hel.12844 [doi]
AB  - BACKGROUND: Failure of second or third-line eradication treatment against 
      Helicobacter pylori (H. pylori) is principally caused by antimicrobial resistance 
      and reduced treatment adherence. AIMS: To evaluate the efficacy and safety of 
      culture-based rescue eradication treatments in patients who have previously 
      experienced failed eradication treatment. METHODS: Patients who had persistent 
      H. pylori infection following at least one eradication treatment were recommended 
      to undergo culture analysis to determine the minimal inhibitory concentrations of 
      various antimicrobials via endoscopic resection. Consenting patients were 
      assigned one of four therapeutic treatments based on an algorithm determined by 
      antimicrobial resistance. These treatments consisted of 7 or 14-day 
      administration of clarithromycin-containing proton pump inhibitor (PPI) triple 
      therapy; esomeprazole, moxifloxacin, and amoxicillin (MEA) therapy; esomeprazole, 
      bismuth, metronidazole, and tetracycline (quadruple) therapy; or lansoprazole, 
      rifabutin, and amoxicillin (RLA) therapy. Eradication efficacy, adherence, and 
      adverse events were assessed aside clinical outcomes. RESULTS: A total of 132 
      patients were enrolled, with 84 patients completing the study. The overall 
      resistance rates to amoxicillin, clarithromycin, metronidazole, and moxifloxacin 
      were 13.1%, 83.3%, 47.6%, and 71.4%, respectively. The patients were allocated to 
      the PPI triple (n = 11), MEA (n = 15), quadruple (n = 53), or RLA triple (n = 5) 
      therapy group. The eradication rates in the intention-to-treat and per-protocol 
      analyses were 90.5% (76 of 84 patients) and 93.8% (76 of 81 patients), 
      respectively. Nausea was the most frequent adverse event (25.0%). CONCLUSIONS: As 
      a rescue therapy, culture-based susceptibility-guided eradication treatment was 
      both effective and safe, even for patients exhibiting high antimicrobial 
      resistance.
CI  - (c) 2021 John Wiley & Sons Ltd.
FAU - Lee, Jung Won
AU  - Lee JW
AD  - Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan 
      University School of Medicine, Changwon, South Korea.
FAU - Kim, Nayoung
AU  - Kim N
AUID- ORCID: 0000-0002-9397-0406
AD  - Department of Internal medicine, Seoul National University Bundang Hospital, 
      Seongnam, South Korea.
AD  - Department of Internal Medicine and Liver Research Institute, Seoul National 
      University College of Medicine, Seoul, South Korea.
FAU - Nam, Ryoung Hee
AU  - Nam RH
AD  - Department of Internal medicine, Seoul National University Bundang Hospital, 
      Seongnam, South Korea.
FAU - Jang, Jae Young
AU  - Jang JY
AD  - Department of Internal medicine, Seoul National University Bundang Hospital, 
      Seongnam, South Korea.
FAU - Choi, Yonghoon
AU  - Choi Y
AD  - Department of Internal medicine, Seoul National University Bundang Hospital, 
      Seongnam, South Korea.
FAU - Lee, Dong Ho
AU  - Lee DH
AD  - Department of Internal medicine, Seoul National University Bundang Hospital, 
      Seongnam, South Korea.
AD  - Department of Internal Medicine and Liver Research Institute, Seoul National 
      University College of Medicine, Seoul, South Korea.
LA  - eng
GR  - 06-2019-001/Seoul National University Bundang Hospital Research fund./
GR  - 06-2020-184/Seoul National University Bundang Hospital Research fund./
PT  - Journal Article
DEP - 20210812
PL  - England
TA  - Helicobacter
JT  - Helicobacter
JID - 9605411
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Anti-Infective Agents)
RN  - 0 (Proton Pump Inhibitors)
RN  - 140QMO216E (Metronidazole)
RN  - 804826J2HU (Amoxicillin)
RN  - H1250JIK0A (Clarithromycin)
SB  - IM
MH  - Amoxicillin/therapeutic use
MH  - Anti-Bacterial Agents/adverse effects
MH  - *Anti-Infective Agents/therapeutic use
MH  - Clarithromycin/therapeutic use
MH  - Drug Resistance, Bacterial
MH  - Drug Therapy, Combination
MH  - *Helicobacter Infections/drug therapy
MH  - *Helicobacter pylori
MH  - Humans
MH  - Metronidazole/adverse effects
MH  - Proton Pump Inhibitors/adverse effects
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Helicobacter pylori
OT  - antibiotics
OT  - eradication
OT  - rescue therapy
OT  - resistance
EDAT- 2021/08/13 06:00
MHDA- 2021/10/16 06:00
CRDT- 2021/08/12 06:54
PHST- 2021/08/02 00:00 [revised]
PHST- 2021/06/18 00:00 [received]
PHST- 2021/08/03 00:00 [accepted]
PHST- 2021/08/13 06:00 [pubmed]
PHST- 2021/10/16 06:00 [medline]
PHST- 2021/08/12 06:54 [entrez]
AID - 10.1111/hel.12844 [doi]
PST - ppublish
SO  - Helicobacter. 2021 Oct;26(5):e12844. doi: 10.1111/hel.12844. Epub 2021 Aug 12.