Systematic Evaluation of Helicobacter pylori Susceptibility to Antibiotics Before First-Line Treatment: A Cohort Study
Abstract
BACKGROUND: European guidelines recommend that susceptibility tests be routinely performed, even before prescribing first-line treatment of Helicobacter pylori infection. However, empirical treatments are the rule in France, and susceptibility-guided treatments are the exception.
OBJECTIVE: We aimed to report our experience of systematic antibiotic susceptibility testing before first-line treatment.
METHODS: Prospective registration of all esofagogastroduodenoscopies performed in a community hospital from December 2023 to December 2024. Antral and fundic biopsies were performed, at the discretion of the endoscopist, for histological examination, polymerase chain reaction (PCR) and culture without any freezing.
RESULTS: Overall, 3566 adults underwent esofagogastroduodenoscopy, 1785 (50.1%) were tested and H. pylori infection was diagnosed in 308 (17.3%) [95% confidence interval (CI): 15.5%-19.0%] individuals. The sensitivity of PCR for the diagnosis of H. pylori infection was 99.7%, significantly higher than those of histology (94.1%) and culture (95.2%) (p < 0.01). Clarithromycin resistance was observed in 22.6% [95% CI: 17.9%-27.3%] and levofloxacin resistance in 18.6% [95% CI: 14.1%-23.2%] of cases. Among 285 patients treated, susceptibility-guided triple therapy was prescribed in 84.9% of cases (73.3% amoxicillin-clarithromycin, 11.6% amoxicillin-levofloxacin) and quadruple bismuth therapy in 14.4% of cases. The eradication rates were 98.1% [95% CI: 96.0%-100%] for triple…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 3,566 participants or records.
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