Original articlePretreatment antimicrobial susceptibility testing is cost saving in the eradication of Helicobacter pylori☆
Section snippets
Patients and study protocol
We studied 150 consecutive H. pylori-infected patients with dyspeptic symptoms and without previous H. pylori eradication treatment. These patients were referred to our endoscopy unit from general practitioners because of a positive serology and/or 13C-urea breath test for H. pylori. Patients were randomized according to a predetermined randomization schedule to receive standard triple therapy or susceptibility testing-based therapy. Patients were randomly assigned with equal allocation to the
Results
A total of 150 patients were enrolled into the randomized parallel-group study, with 75 patients in the susceptibility test group and 75 patients in the standard triple therapy group. Two patients in each group discontinued therapy because of side effects (diarrhea, nausea, and vomiting) and were therefore excluded from analysis. The rate of culture and testing for resistance was 72 of 75 (96%). A second endoscopy was performed in 3 patients, and the success rate for culture and testing was 3
Discussion
H. pylori infection is a chronic, transmissible infectious disease that causes gastritis and peptic ulcer and is implicated in the development of carcinoma of the distal stomach.13, 14 Successful therapy requires a combination of drugs that prevents the emergence of resistance and reaches the bacteria within its various niches. The ideal eradication regimen would be one that is simple (e.g., few medications and short duration) and essentially 100% effective. Regimens that have been proven
Acknowledgements
The authors thank Mr. A. Piccolo (endoscopy nurse) for assistance.
References (19)
Epidemiology and mechanism of antibiotic resistance in Helicobacter pylori
Gastroenterology
(1998)Antibiotic resistance in Helicobacter pyloriimplications for therapy
Gastroenterology
(1998)- et al.
Pretreatment antimicrobial-susceptibility testing in the eradication of Helicobacter pylori infection (letter)
Am J Gastroenterol
(2000) - et al.
Voyage of Helicobacter pylori in human stomachodyssey of a bacterium
Dig Liver Dis
(2002) - et al.
Costs of diagnosis and treatment of Helicobacter pylori infectionwhen does choosing the treatment regimen based on susceptibility testing become cost-effective?
Am J Gastroenterol
(1999) - et al.
Incidence of secondary Helicobacter pylori resistance to antibiotics in treatment failures after 1-week proton pump inhibitor-based triple therapiesa prospective study
Dig Liver Dis
(2000) - et al.
Treatment failures and secondary resistance to antibiotics. A growing concern in Helicobacter pylori therapy
Dig Liver Dis
(2000) Economics of Helicobacter pylori eradication therapy
Eur J Gastroenterol Hepatol
(1997)- et al.
Molecular response of gastric epithelial cells to Helicobacter pylori-induced cell damage
Cell Microbiol
(1999)
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Supported in part by grants from Ministero per la Istruzione, Università e Ricerca, Consiglio Nazionale delle Ricerche, and C.I.R.A.N.A.D., Seconda Università di Napoli.