Table 2.
Susceptibility Testing-Guided Therapy in Third-Line Treatment for Helicobacter pylori Infection
| Author (year) | Study design |
No. of Tx | Test used | Culture success rate |
CLA/LEV/MET resistance rate, % |
Rules to choose regimen | Duration, day |
No. of cases |
ITT analysis | PP analysis |
|---|---|---|---|---|---|---|---|---|---|---|
| Gasbarrini et al. (2000)38 | NC | 2 | E-test | 80 (39/49) | 56/-/56 | Quadruple: PPIs, bismuth, plus 2 antibiotics | 7 | 49 | 61 (30/49) | 77 (30/39) |
| Vicente et al. (2002)39 | NC | 2 | E-test | 97.6 | 51/-/43 | Quadruple: PPIs, bismuth, plus 2 antibiotics | 14 | 40 | 60 (24/40) | 63 (24/38) |
| Cammarota et al. (2004)40 | NC | 2 | E-test | 96 (94/98) | 95/31/100 | Quadruple: PPIs, bismuth, doxycycline and amoxicillin or triple PPIs, amoxicillin and levofloxacin or clarithromycin | 7 | 94 | 90 (85/94) | 91 (85/93) |
| Yahav et al. (2006)41 | NC | 1 or 2 | E-test | 100 (49/49) | 59/-/47 | Triple therapy or quadruple therapy | 7 | 49 | 86 (42/49) | 86 (42/49) |
| Tay et al. (2012)42 | NC | 1 or 2 | E-test | 98.7 (306/310) | 94/6/68 | Quadruple: PPIs, amoxicillin, ciprofloxacin, and rifabutin; PPIs, bismuth, furazolidone, amoxicillin or rifabutin; PPIs, bismuth, tetracycline, furazolidone or amoxicillin | 10 | 310 | 94 (291/310) | 94 (291/310) |
| Fiorini et al. (2013)43 | NC | 1 or 2 | E-test | 93 (236/254) | 92/44/73 | Triple: PPI, amoxicillin, levofloxacin or rifabutin | 10–12 | 254 | 83 (211/254) | 90 (212/236) |
| Liou et al. (2013)44 | NC | 2 or more | PCR and agar dilution | 95 (128/135)/ 74 (100/135) |
87/47/58 | Non-bismuth quadruple: PPIs, amoxicillin, metronidazole, levofloxacin or clarithromycin or tetracycline | 14 | 135 | 81 (109/135) | 83 (109/132) |
| Costa et al. (2017)45 | NC | 2 | E-test | 100 | 86/52/67 | Triple therapy with PPIs, amoxicillin, susceptible drug or PPIs, doxycycline, and rifampicin | 8–14 | 42 | 60 (25/42) | 62 (24/39) |
| Liou et al. (2018)46 | RCT | 2 or more | PCR | 97.8 | 90/61/66 | Non-bismuth quadruple: PPI, amoxicillin, metronidazole, levofloxacin or clarithromycin or tetracycline | 14 | 205 | 78 (160/205) | 78 (156/199) |
| Yu et al. (2019)47 | NC | 1 or more | Agar dilution | 95.8 (206/215) | 94/93.5/81 | Triple therapy with PPI, amoxicillin plus clarithromycin or metronidazole, or levofloxacin | 14 | 200 | 95 (189/200) | 97 (186/192) |
| Bismuth quadruple for multidrug-resistant infections: PPI, bismuth, amoxicillin, and metronidazole |
Data are presented percent (number/number).
No. of Tx, number of prior eradication therapy; CLA, clarithromycin; LEV, levofloxacin; MET, metronidazole; ITT, intention-to-treat; PP, per protocol; NC, noncontrolled study; RCT, randomized controlled trial; PCR, polymerase chain reaction; PPIs, proton pump inhibitors.