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- Title
Susceptibility‐guided therapy for Helicobacter pylori‐infected penicillin‐allergic patients: A prospective clinical trial of first‐line and rescue therapies.
- Authors
Luo, Laisheng; Huang, Yu; Liang, Xiao; Ji, Yingjie; Yu, Lou; Lu, Hong
- Abstract
Background: Helicobacter pylori (H pylori) treatment remains a challenge for penicillin‐allergic patients. Aim: To evaluate the efficacy and tolerability of susceptibility‐guided first‐line and rescue treatment in H pylori‐infected penicillin‐allergic patients. Methods: Consecutive H pylori‐infected patients with penicillin allergy received a 14‐day triple or quadruple therapy based on susceptibility to clarithromycin, levofloxacin, and metronidazole. All received esomeprazole 20 mg twice a day. Metronidazole‐susceptible infections received metronidazole plus clarithromycin or levofloxacin triple therapy if susceptible. Clarithromycin‐ and levofloxacin‐resistant infections received metronidazole plus tetracycline triple therapy. Metronidazole‐resistant infections received a bismuth—high‐dose metronidazole plus clarithromycin or levofloxacin quadruple therapy. Triple‐resistant infections received classical bismuth quadruple therapy with high‐dose metronidazole. Antimicrobial susceptibility was assessed using the E test method. Results: 112 patients were entered (34.8% men, average 47.1 years). Infections in 83.8% (31/37) of treatment‐naive subjects and 12.0% (9/75) (P <.001) receiving rescue treatment were susceptible to at least one of the three tested antibiotics. Overall, susceptibility‐guided therapy achieved eradication rates of 92.9% (104/112, 95% CI 88.1%‐97.7%) by intent‐to‐treat analysis and 99% (100/101, 95% CI 97.1%‐100%) by per‐protocol analysis. All regimens achieved eradication rates greater than 90% (P =.327) in the PP populations. Adverse events were relatively frequent; however, compliance remained high. Conclusion: Susceptibility‐guided therapy proved highly effective for penicillin‐allergic patients. When available and proven locally effective, the alternative was empiric classical bismuth quadruple therapy. This trial is registered with ClinicalTrials.gov as NCT03708848.
- Subjects
HELICOBACTER pylori infections; HELICOBACTER; CLINICAL trials; HELICOBACTER pylori; TETRACYCLINES; ANTIBIOTICS
- Publication
Helicobacter, 2020, Vol 25, Issue 4, p1
- ISSN
1083-4389
- Publication type
Article
- DOI
10.1111/hel.12699