As a rescue treatment, the culture-based susceptibility-guided elimination therapy displayed efficacy and safety, even for people exhibiting high antimicrobial resistance, says a study published in Helicobacter. Jung Won Lee et al. aimed to examine the safety and efficacy of culture-based rescue elimination therapy in individuals who have previously reported failed Helicobacter pylori (H. pylori) elimination therapy.

People who had persistent H. pylori infection after at least 1 elimination therapy were suggested to undergo culture assessment for determining the minimal inhibitory concentrations of various antimicrobials with the aid of endoscopic resection. Participants were allocated 1 of 4 treatments on the basis of an algorithm assessed by antimicrobial resistance. Overall, 132 people were recruited, with 84 people finishing the study.

Participants were assigned to seven or 14-day administration of (i) clarithromycin-containing proton pump inhibitor (PPI) triple group (n = 11),  (ii) esomeprazole, moxifloxacin, and amoxicillin (MEA) therapy group (n = 15), (iii) esomeprazole, bismuth, metronidazole, and tetracycline (quadruple) therapy group (n = 53), or (iv) lansoprazole, rifabutin, and amoxicillin (RLA) triple therapy group (n = 5) .

Evaluation of H. pylori elimination efficacy, adherence, and adverse events was done. The overall resistance rates to moxifloxacin, metronidazole, clarithromycin, and amoxicillin were 71.4%, 47.6%, 83.3%, and 13.1%, respectively. Figure 1 shows H. pylori elimination rates as per the treatment subgroups. 

Nausea was the most commonly reported adverse event (25.0%). No profound inter-group differences were noted in terms of severe adverse events. Thus, culture-based H. pylori elimination therapy is beneficial for the management of H. pylori infection.