Objectives We aimed to explore the efficacy and safety of tailored therapy guided by genotypic resistance in the first‐line treatment of Helicobacter pylori ( H. pylori ) infection in treatment‐naive patients. Methods Gastric mucosal specimens were taken during gastroscopy, and main mutations of clarithromycin‐ and levofloxacin‐resistant genes were detected by polymerase chain reaction (PCR). Sensitive antibiotics were selected individually for treating H. pylori infection with tailored bismuth‐containing quadruple therapy (BQT) consisting of esomeprazole 20 mg twice daily, bismuth potassium citrate 220 mg twice daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily, or levofloxacin 500 mg once daily, or metronidazole 400 mg four times daily. Safety and patient compliance were assessed 1–3 days after eradication. Treatment outcome was evaluated by urea breath test 4–8 weeks after eradication. Results One hundred and thirty‐two treatment‐naive patients with H. pylori infection were included. PCR results suggested resistance rates of 47.7% and 34.9% for clarithromycin and levofloxacin, respectively, and a dual resistance rate of 18.2%. Eradication rates of tailored BQT were 87.1% and 95.8% by intention‐to‐treat (ITT) analysis and per‐protocol (PP) analysis, respectively. There was no statistically significant difference in the efficacy of 7‐day clarithromycin‐containing, 7‐day levofloxacin‐containing, and 14‐day full‐dose metronidazole‐containing BQT (ITT analysis: P = 0.488; PP analysis: P = 0.833). The incidence of adverse events was 19.7%, and patient compliance was 97.7%. Conclusion Tailored BQT guided by genotypic resistance can achieve satisfactory efficacy, safety, and patient compliance in the first‐line treatment of H. pylori infection.

Objective To determine the resistance patterns of Helicobacter pylori ( H.pylori) strains isolated from patients in Beijing and to explore the influencing factors of antibiotic resistance. Methods From April 2013 to March 2014, Helicobacter pylori culture from mucosa samples of gastric antrum and body of stomach was carried out in 820 RUT positive patients examined by gastroscopy.Resistance to amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and rifampicin was tested. Results Of the 820 specimens, 700 were positive (85.4%).The overall antibiotic resistance rates of isolates obtained were 63.9%(447/700), 54.4%(381/700), 50.1%(351/700), 18.0%(126/700), 7.3%(51/700), and 3.7%(26/700) with respect to metronidazole, levofloxacin, clarithromycin, rifampicin, tetracycline, and amoxicillin, respectively.Multiple drug resistance rate of susceptible to all tested antibiotics was 9.9%(69/700), with a mono resistance rate of 27.1%(190/700), double resistance rate of 29.6%(207/700), triple resistance rate of 24.3%(170/700), quadruple resistance rate of 7.4%(52/700), quintuple resistance rate of 1.6% (11/700), and sextuple resistance rate of 0.1% (1/700), respectively.Single factor analysis showed that the resistance rate of clarithromycin in patients with non ulcer dyspepsia was significantly higher than that in patients with peptic ulcer (χ2 =11.619, P =0.001, OR =1.834, 95%CI:1.366 -2.424).The resistance rate of metronidazole in female patients wassignificantly higher than in male patients (χ2 =5.674, P=0.017, OR=1.486, 95%CI:1.176 -1.824).The resistance rate of levofloxacin in middle-aged and elderly patients was significantly higher than that in young patients (χ2 =6.731, P=0.035, OR=1.204, 95%CI:1.076-1.385), and in female patients was significantly higher than in male patients (χ2 =6.693, P=0.010, OR=1.502, 95%CI:1.181-1.786).The results of the multivariate analysis confirmed that the above factors can be considered as the factors affecting the change of resistance rates. Conclusion H.pylori resistance level is very high to metronidazole, clarithromycin, and levofloxacin, high to rifampicin, and relatively low to tetracycline and amoxicillin in Beijing.Multiple drug resistance is at high prevalence.

Compliance was 100% in both groups.The adverse event rates were 12.8% (10/78) and 24.6% (19/77) in the MOX-ST and CLA-ST group, respectively (P = 0.038).Most of the adverse events were mild-to-moderate in intensity; there was none serious enough to cause discontinuation of treatment in either group.In multivariate analysis, advanced age (≥ 60 years) was a significant independent factor related to the eradication failure in the CLA-ST group (adjusted odds ratio [OR]: 2.13, 95% confidence interval [CI]: 1.97-2.29,P = 0.004), whereas there was no significance in the MOX-ST group.Conclusions: The 14-day moxifloxacin-based sequential therapy is effective.Moreover, it shows excellent patient compliance and safety compared to the 14-day clarithromycin-based sequential therapy.

AIM:To determine the resistance patterns of Helicobacter pylori(H.pylori) strains isolated from patients in Beijing and monitor the change of antibiotic resistance over time.METHODS:In this prospective,serial and crosssectional study,H.pylori cultures were successfully obtained from 371 and 950 patients(never receiving eradication) during 2009-2010 and 2013-2014,respectively.Resistance to amoxicillin,clarithromycin,metronidazole,levofloxacin,tetracycline,and rifampicin was determined by Epsilometer test.RESULTS:The resistance rates of isolates obtained during 2009-2010 were 66.8%,39.9%,34.5%,15.4%,6.7%,and 4.9% to metronidazole,clarithromycin,levofloxacin,rifampicin,amoxicillin and tetracycline,respectively; and the corresponding rates for isolates during 2013-2014 were 63.4%,52.6%,54.8%,18.2%,4.4% and 7.3%,respectively.The resistance rates to clarithromycin and levofloxacin were significantly increased after four years.In 2009-2010,14.6% of H.pylori isolates were susceptible to all tested antibiotics,with mono(33.7%),double(28.3%),triple(16.7%),quadruple(6.2%),quintuple(0.3%) and sextuple resistance(0.3%) also being detected.In 2013-2014,9.4% were susceptible to all tested antibiotics,and mono(27.6%),double(28.4%),triple(24.9%),quadruple(7.3%),quintuple(2.3%) and sextuple resistance(0.1%) was also observed.More multiple resistant H.pylori isolates were found during 2013-2014.Gender(to levofloxacin and metronidazole),age(to levofloxacin) and endoscopic findings(to clarithromycin) were independent factors influencing antibiotic resistance.CONCLUSION:H.pylori resistance to commonly used antibiotics in Beijing is high with increased multiple antibiotic resistance.