Background Due to increasing prevalence of antibiotic resistant Helicobacter pylori, the number of patients who require rescue treatment (after >1 failed eradication attempts) is increasing. First-line treatment for H. pylori is not standardised, therefore it’s difficult to recommend a specific rescue treatment. Prescribing a tailored regimen based on antibiotic sensitivities upon first eradication failure may be most effective.
Aim To examine the efficacy of a tailored regimen based on antimicrobial susceptibility as a rescue treatment for H. pylori.
Method Patients previously treated for H. pylori and undergoing endoscopy were prospectively recruited. Biopsies from H. pylori-positive patients (CLO test) were processed for sensitivity testing. Patients received treatment based on antibiotic sensitivities, for 7/14 days. A follow-up breath test was performed 8 weeks post-treatment.
Results Of 881 gastroscopies done between April 2013- February 2017, 190 (22%) were H. pylori positive. Of these, 76 (40%) were previously treated: 41 (54%) received one prior treatment and 35 (46%) received >1. To date, 44 (58%) patients have completed the study; 20 (45%) received levofloxacin triple therapy; 10 (23%) a PPI and 2 antibiotics based on their sensitivities; 10 (23%) bismuth quadruple and 4 (9%) clarithromycin triple therapy. The efficacy of tailored treatment by intention-to-treat and per protocol analysis was poor, at 47.3% (26/55) and 59.1% (26/44) respectively. Patients who received one previous treatment were significantly more likely to achieve eradication than those who received >1 previous treatment (76.2% vs 43.5%, p=0.04).
Conclusions Rescue eradication rates are disappointing and emphasise the importance of eradicating H. pylori infection the first time round.