Abstract
Recently in Korea, where triple therapy is accepted as the first-line Helicobacter pylori (H. pylori) eradication treatment, antibiotic resistance to clarithromycin has increased considerably, resulting in eradication rates of less than 80%. We investigated the efficacy of tailored therapy after a clarithromycin resistance test compared with empirical therapy for H. pylori eradication. The cost-effectiveness of H. pylori eradication success was evaluated according to the average medical cost per patient. A total of 364 patients were enrolled in the study. The first-line H. pylori eradication rate was significantly higher in patients who received tailored therapy than in those who received empirical therapy. The total medical costs for the tailored and empirical groups were 46,374 Won and 53,528 Won. The total treatment period for each ultimately successful eradication in the tailored group was 79.8 ± 2.8 days, which is shorter than that of the empirical group (99.2 ± 7.4 days). The rate of eradication-related adverse events for the tailored group and empirical group was 12.9% and 14.8%, respectively. Tailored therapy could be a useful option to achieve a higher successful eradication rate, shorter treatment periods, and lower medical costs than empirical therapy in the era of increasing antibiotic resistance.
Highlights
Helicobacter pylori (H. pylori) is associated with peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric cancer [1,2,3], and Korean guidelines recommend triple therapy as the first-line eradication treatment for H. pylori infection [4]
We included 435 subjects who met the following criteria: (1) the presence of H. pylori was confirmed by rapid urease test, histology such as Giemsa stain, urea breath test (UBT), or dual-priming oligonucleotide (DPO)-polymerase chain reaction (PCR) test; (2) patients receiving empirical therapy or tailored therapy based on the DPO-PCR results
Empirical therapy was given to 155 patients, and 209 patients received tailored therapy
Summary
Helicobacter pylori (H. pylori) is associated with peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric cancer [1,2,3], and Korean guidelines recommend triple therapy as the first-line eradication treatment for H. pylori infection [4]. Due to the increase of antibiotic-resistant strains, the eradication rate has gradually decreased [5,6], and several clinical studies have reported that the eradication rate of triple therapy is less than 80% [7,8,9]. Kuo et al recently reported on patients with refractory H. pylori infection in Taiwan. Dual resistance to both clarithromycin and levofloxacin was found in 73.2%.
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