Eradication of Helicobacter pylori According to 23S Ribosomal RNA Point Mutations Associated With Clarithromycin Resistance

Background. Clarithromycin-resistant Helicobacter pylori is associated with point mutations in the 23S ribo-somal RNA (rRNA) gene. Methods. 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. Results. 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. Conclusion. The rate of H. pylori eradication among patients who received tailored therapy on the basis of de-tection of a clarithromycin resistance mutation by polymerase chain reaction was much higher than the rate among patients who received a standard triple therapy regimen