Eradication of Helicobacter pylori according to 23S ribosomal RNA point mutations associated with clarithromycin resistance.

Hyun Jeong Lee, Jin Il Kim, Dae Young Cheung, Tae Ho Kim, Eun Jung Jun, Jung-Hwan Oh, Woo Chul Chung, Byung-Wook Kim, Sung Soo Kim, Soo-Heon Park, Jae Kwang Kim

Index: J. Infect. Dis. 208(7) , 1123-30, (2013)

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Abstract

Clarithromycin-resistant Helicobacter pylori is associated with point mutations in the 23S ribosomal RNA (rRNA) gene.A total of 1232 patients participated and were divided into 2 control groups and 1 case group. Patients in the APC control group, which consisted of 308 randomly assigned participants, were treated with standard triple therapy, consisting of amoxicillin, rabeprazole, and clarithromycin; 308 participants in the APM control group were treated with amoxicillin, rabeprazole, and metronidazole. For the 616 participants in the case group, a test for point mutations in the 23S rRNA gene of H. pylori was conducted. A total of 218 individuals in the case group received a new tailored therapy regimen, in which amoxicillin, rabeprazole, and clarithromycin were given in the absence of a mutation, whereas clarithromycin was replaced by metronidazole if the mutation was detected.The rate of eradication of H. pylori in the tailored group was 91.2% (176/193), which was significantly higher than that in the APC (75.9% [214/282]; P < .001) and APM (79.1% [219/277]; P < .001) control groups.The rate of H. pylori eradication among patients who received tailored therapy on the basis of detection of a clarithromycin resistance mutation by polymerase chain reaction was much higher than the rate among patients who received a standard triple therapy regimen.NCT0145303.