Seven-day genotypic resistance-guided triple eradication therapy can be highly effective.

Background: The efficacy and applicability of molecular testing to guide the selection of antibiotics in triple ( eradication regimens have not been reported. We tested a 7-day, genotypic resistance-guided triple eradication therapy in a high-resistance setting.

Methods: Consecutive dyspeptic patients with infection were prospectively enrolled. Genotypic resistances to clarithromycin ( mutations) and fluoroquinolones ( mutations) were determined from gastric biopsy specimens using a commercially available molecular assay (GenoType HelicoDR). A tailored genotypic resistance-guided 7-day triple therapy comprised esomeprazole, amoxicillin, and either clarithromycin (wild-type ), levofloxacin ( mutated/wild-type ) or rifabutin (both / mutated). eradication was confirmed by C-urea breath test.

Results: Of 148 subjects screened, 51 patients were enrolled (male/female: 27/24, mean age: 50.7±11.4 years, treatment-naïve/-experienced: 32/19). The molecular kit was easily implemented, allowing for rapid (within 24 h) and relatively inexpensive determination of resistance (clarithromycin: 47.1%, fluoroquinolones: 15.7%, dual clarithromycin/fluoroquinolones: 7.8%). For patients who received clarithromycin-, levofloxacin- and rifabutin-containing triple therapy, the respective eradication rates were 24/27, 20/20, and 2/4 by intention-to-treat (ITT); and 24/24, 19/19 and 2/3 by per-protocol (PP) analysis. Overall eradication rates were 90.2% (95% confidence interval [CI] 77.8-96.3%) by ITT and 97.8% (95%CI 87-99.8%) by PP analysis, showing no significant difference between treatment-naïve and -experienced patients (ITT: 87.5% vs. 94.7%, P=0.64; PP: 96.4% vs. 100%, respectively, P=1.00).

Conclusions: Regardless of prior treatment history, a genotypic resistance-guided 7-day triple therapy, based on a simple molecular assay, achieved a high eradication rate.