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In the third-line therapy for H. pylori infection, culture-guided therapy plus high-dose PPI has superior efficacy than empirical therapy.
According to a real-world clinical study published in "Journal of Gastroenterology and Hepatology", culture-guided therapy combined with high-dose proton pump inhibitor (PPI) had a greater eradication rate than empirical therapy when used as the third-line treatment for Helicobacter pylori (H. pylori) infection.
Researchers sought to assess the effectiveness of culture-based therapy and empirical therapy with PPI for H. pylori management. H. pylori-infected patients who had experienced a minimum of 2 unsuccessful eradication attempts were given anti-H. pylori treatment (as per outcomes of antimicrobial sensitivity tests) along with high-dose Rabeprazole and/or Bismuth.
They were divided into three groups: (A) Those with positive culture results with one to two susceptible antibiotics received culture-guided Bismuth-containing therapy, (B) Those with positive culture results with three or more susceptible antibiotics received culture-guided non-Bismuth quadruple therapy, and (C) Those with negative culture results received therapy guided by high-dose Rabeprazole plus Amoxicillin, Levofloxacin and Tetracycline.
At week eight, a post-treatment evaluation was carried out. Overall, 126 patients were enrolled. The eradication rates of empirical therapy (n = 30), culture-guided Bismuth-containing therapy (n = 46), and culture-guided non-Bismuth quadruple treatment (n = 50) are depicted in Table 1:
Overall, culture-guided treatment outperformed empirical therapy in terms of eradication rate (85.4% vs. 66.7%). In the third-line therapy for H. pylori infection, culture-guided treatment with high-dose PPI had a greater rate of elimination than empirical treatment with high-dose PPI. When compared to rescue therapy using three susceptible antibiotics, rescue therapy using Bismuth and two susceptible antibiotics is not inferior.
Journal of Gastroenterology and Hepatology
The efficacy of culture-guided versus empirical therapy with high-dose proton pump inhibitor as third-line treatment of Helicobacter pylori infection: A real-world clinical experience
Jiunn-Wei Wang et al.
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