Susceptibility-guided and empiric therapy equally effective in H. pylori infection
Susceptibility‐guided therapy is as effective as empiric modified bismuth quadruple therapy for the first-line treatment of Helicobacter pylori infection, with both yielding excellent eradication rates, as shown in a recent trial.
Researchers conducted a multicentre superiority‐design trial, which randomly assigned 382 patients with H. pylori infection to (a) susceptibility‐guided therapies containing esomeprazole 20 mg and amoxicillin 1 g twice daily plus clarithromycin 500 mg, metronidazole 400 mg twice daily, or levofloxacin 500 mg daily for susceptible infections or bismuth 220 mg twice daily and metronidazole 400 mg four times daily for triple‐resistant infections; or to (b) empiric therapy containing esomeprazole 20 mg, bismuth 220 mg twice daily, amoxicillin 1 g and metronidazole 400 mg thrice daily.
Rates of H. pylori eradication were high and similar in the susceptibility‐guided and the empiric regimens (per-protocol rates: 97.7 percent vs 97.6 percent; p=1.00; intent‐to‐treat rates: 91.6 percent vs 85.4 percent; p=0.12).
Overall, susceptibility‐guided therapy was not superior to empiric therapy, with a difference of 0.1 percent in per‐protocol rate and 6.2 percent in intent‐to‐treat rate. Furthermore, both treatment approaches had high adherence and were associated with low adverse event rates.
In light of the findings, researchers pointed out that choosing between the two approaches would depend on availability of susceptibility testing and/or a locally highly effective empiric therapy.