Tailored eradication strategy concomitant therapy for eradication treatment in Korean patients.

Background: Antibiotic resistance to ) infection, which ultimately results in eradication failure, has been an emerging issue in the clinical field. Recently, to overcome this problem, an antibiotic sensitivity-based tailored therapy (TT) for infection has received attention.

Aim: To investigate the efficacy and safety profiles of TT for infection treatment compared to a non-bismuth quadruple therapy, concomitant therapy (CT) regimen.

Methods: We included patients (> 18 years) with an infection and without a history of eradication who visited the Gil Medical Center between March 2016 and October 2020. After being randomly assigned to either the TT or CT treatment group in 1 to 1 manner, patient compliance, eradication success rate (ESR), and patient-reported side effects profiles were assessed and compared between the two groups. infection was diagnosed using a rapid urease test, Giemsa stain, or dual priming oligonucleotide polymerase chain reaction (DPO-PCR). Tailored eradication strategy based through the presence of a 23S ribosomal RNA point mutation. For the TT group, a DPO-PCR test, which detected A2142G and/or A2143G point mutations, and a clarithromycin resistance test were performed. Patients in the clarithromycin-resistant group were treated with a bismuth-containing quadruple combination therapy, while those with sensitive results were treated with the standard triple regimen.

Results: Of the 217 patients with a treatment naive infection, 110 patients [mean age: 58.66 ± 13.03, men, = 55 (50%)] were treated with TT, and 107 patients [mean age: 56.67 ± 10.88, men, = 52 (48.60%)] were treated with CT. The compliance (TT CT, 100% 98.13%, = 0.30), and follow-up loss rates (8.18% 9.35%, = 0.95) were not significantly different between the groups. The ESR after treatment was also not statistically different between the groups (TT CT, 82.73% 82.24%, = 0.95). However, the treatment-related and patient-reported side effects were significantly lower in the TT group than in the CT group (22.77% 50.52%, < 0.001).

Conclusion: The DPO-based TT regimen shows promising results in efficacy and safety profiles as a first-line eradication regimen in Korea, especially when physicians are confronted with increased antibiotic resistance rates.