Prospective comparative study of the treatment of Helicobacter pylori with antibiotic susceptibility testing-guided triple therapy compared to quadruple therapy with bismuth-metronidazole-tetracycline subcitrate

Introduction: the current indicated first-line treatment for Helicobacter pylori (H. pylori) infection is the quadruple therapy with bismuth-metronidazole-tetracycline subcitrate, or the quadruple concomitant therapy without bismuth. The triple therapy was abandoned due to its low eradication rates, partly derived from an increase in antibiotic resistance. The aim of this study was to compare the H. pylori eradication rates guided by antibiotic susceptibility testing (AST) versus bismuth-metronidazole-tetracycline subcitrate. Methods: a specimen was taken prospectively for culture and antibiotic susceptibility testing (AST) from all patients diagnosed with H. pylori infection using gastroscopy, and they were randomized to receive triple therapy depending on the results of the AST, or quadruple therapy with bismuth-metronidazole-tetracycline subcitrate. The eradication rates of both groups were analyzed using fecal antigen. The adherence and side effects of the treatment were also analyzed. Results: of the 108 patients with H. pylori infection, 55 received bismuth-metronidazole-tetracycline subcitrate and 53 AST-guided triple therapy. The eradication rates were 92.7 % with bismuth-metronidazole-tetracycline subcitrate and 90.6 % in the AST-guided group, and the difference was statistically significant. There were also no differences found in adherence or side effects. Conclusions: the treatment of H. pylori with AST-guided triple therapy is effective, especially in regions with high rates of antibiotic resistance. Keywords: Helicobacter pylori. Eradication. Antibiotic resistance. Antibiotics.