Abstract

Background: Mongolia has a high prevalence of Helicobacter pylori infection and gastric cancer. We conducted a prospective, randomized, single-blind study to evaluate the efficacy of common regimens in Mongolia and to obtain specimens for susceptibility testing.Methods: Empiric treatments: 270 patients with confirmed H. pylori infection were randomized to receive 10 days clarithromycin-triple therapy (Clari-TT) (n = 90), modified bismuth quadruple therapy (M-BQT) (n = 90), or sequential therapy (ST) (n = 90). A second group of 46 patients received susceptibility-based Clari-TT. H. pylori was cultured from 131 patients and susceptibility testing was performed. H. pylori eradication was confirmed by stool antigen 4 weeks after the therapy.Results: Intention-to-treat (ITT) analysis cure rates were 71.1% (95% CI = 61.7–80.5%) for Clari-TT, 87.8% (95% CI = 81–94.6%) for M-BQT, 67.8% (95% CI = 58.1–77.5%) for ST vs. 89.1% (95% CI = 86–98.2%) for susceptibility-based Clari-TT. Per-protocol (PP) analysis results for these therapies were 72.7% (63.4–82%), 89.8% (83.5–96.1%), 68.5% (58.8–78.2%), and 97.6% (89.5–99.8%), respectively. Among 131 cultured H. pylori, resistance rates to amoxicillin, clarithromycin, and metronidazole were 8.4, 37.4, and 74%, respectively.Conclusion: In Mongolia, the prevalence of H. pylori resistance is high requiring bismuth quadruple therapy or susceptibility-based therapy to obtain acceptable cure rates.

Highlights

  • As in most developing countries, the prevalence of Helicobacter pylori infection is high in Mongolia (Nyamdavaa, 2013) with reported prevalence ranging of 80% among adults (Matsuhisa et al, 2015; Khasag et al, 2018), 64% among adolescents, and 65 and 100% among pediatric patients with gastric comorbidity (Go, 2013)

  • The results from this study provided evidence that our modified bismuth quadruple and susceptibilitybased therapies were more effective than Clari-TT and sequential therapy (ST) in a country with high resistance for clarithromycin and metronidazole

  • Helicobacter pylori resistance rate to metronidazole, clarithromycin, and amoxicillin are high in Mongolia

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Summary

Introduction

As in most developing countries, the prevalence of Helicobacter pylori infection is high in Mongolia (Nyamdavaa, 2013) with reported prevalence ranging of 80% among adults (Matsuhisa et al, 2015; Khasag et al, 2018), 64% among adolescents, and 65 and 100% among pediatric patients with gastric comorbidity (Go, 2013). Information regarding H. pylori antibiotic resistance in Mongolia is scanty with a single prior study reporting the resistance rates of 35.5% for clarithromycin, 68.4% for metronidazole, 23% for amoxicillin, 25% for tetracycline, 26.2% for erythromycin, and 14.5% for nitrofurantoin (BolorErdene et al, 2017). Mongolia has a high prevalence of Helicobacter pylori infection and gastric cancer. We conducted a prospective, randomized, single-blind study to evaluate the efficacy of common regimens in Mongolia and to obtain specimens for susceptibility testing

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