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Published in: Digestive Diseases and Sciences 2/2018

01-02-2018 | Original Article

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

Authors: Bei Tan, Jyh-Chin Yang, Carol L. Young, Shrinivas Bishu, Stephanie Y. Owyang, Mohamad El-Zaatari, Min Zhang, Helmut Grasberger, Jia-ming Qian, John Y. Kao

Published in: Digestive Diseases and Sciences | Issue 2/2018

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Abstracts

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.
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Metadata
Title
Helicobacter pylori Antimicrobial Susceptibility Testing-Guided Salvage Therapy in the USA: A Real Life Experience
Authors
Bei Tan
Jyh-Chin Yang
Carol L. Young
Shrinivas Bishu
Stephanie Y. Owyang
Mohamad El-Zaatari
Min Zhang
Helmut Grasberger
Jia-ming Qian
John Y. Kao
Publication date
01-02-2018
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 2/2018
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-017-4880-8

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