Optimizing the MIC breakpoints of amoxicillin and tetracycline for antibiotic selection in the rescue therapy of H. pylori with bismuth quadruple regimen

• Published in: European journal of clinical pharmacology 2020-11, Vol.76 (11), p.1581-1589
• Main Authors: Hsieh, Ming-Tsung, Chang, Wei-Lun, Wu, Chung-Tai, Yang, Hsiao-Bai, Kuo, Hsin-Yu, Lin, Meng-Ying, Cheng, Hsiu-Chi, Tsai, Yu-Chin, Sheu, Bor-Shyang
• Format: Article
• Language: English
• Subjects: Biomedical and Life Sciences; Biomedicine; Pharmacoepidemiology and Prescription; Pharmacology/Toxicology
• ISSN: 0031-6970; 1432-1041
• DOI: 10.1007/s00228-020-02938-5

Purpose H. pylori with triple-drug resistance (TR) to clarithromycin, metronidazole, and levofloxacin limits the success of rescue therapy. We aimed to identify the optimal breakpoints of antibiotic minimal inhibitory concentration (MIC) to predict the success of rescue therapy for TR H. pylori infection. Methods We consecutively enrolled 430 patients with at least one course of failed H. pylori eradications to receive an H. pylori culture for antibiotic MIC test. Seventy-three (17%) had TR H. pylori infection (MIC of clarithromycin > 0.5, levofloxacin > 1, and metronidazole > 8 mg/L, respectively). Sixty-nine cases with TR H. pylori infection received rescue therapy with either ATBP (amoxicillin, tetracycline, bismuth, and PPI) or MTBP (metronidazole, tetracycline, bismuth and PPI) for 7–14 days. Fourteen patients with positive 13 C-urea breath test after the first rescue therapy were retreated with a crossover second rescue therapy. Results The MTBP regimen had higher eradication success than the ATBP regimen as the first rescue therapy for TR H. pylori (intent-to-treat (ITT) analysis, 70.3 vs. 46.9%, p  = 0.048; per protocol (PP) analysis, 78.8% vs. 51.7%, p  = 0.025). For MTBP regimen, tetracycline MIC ≤ 0.094 mg/L ( p