Correlation analysis between drug resistance of Helicobacter pylori and the clinical eradication efficacy of bismuth-based quadruple therapies

Objective To investigate the correlation between the drug resistance of Helicobacter pylori (H.pylori) and clinical eradication efficacy of bismuth-based quadruple therapies, and to guide clinical rational drug use in the region. Methods A total of 260 patients with H. pylori infections were collected. H. pylori from biopsied gastric mucosa tissues were isolated and cultured. Drug resistant rates of isolated H. pylori to metronidazole, clarithromycin, amoxicillin, levofloxacin and furanzolidone were tested. Patients were randomly divided into clarithromycin, levofloxacin, furanzolidone and metronidazole groups by completely randomized design. All patients received bismuth potassium 220 mg, esomeprazole 20 mg and amoxicillin 1 000 mg twice daily, and according to group received clarithromycin 500 mg, levofloxacin 200 mg, furanzolidone 100 mg and metronidazole 400 mg, twice daily, espectively. The treatment course was 10 days. At least four weeks after treatment, 13Curea breath test or 14Curea breath test was taken. According to the intention to treat (ITT) and per-protocal (PP), the eradication rate of each group was caculated. Chi square test was performed to compare the differences between groups. Results The drug resistant rate of H. pylori to metronidazole, clarithromycin, amoxicillin, levofloxacin and furanzolidone was 94.2%(146/155), 21.3%(33/155), 2.6%(4/155), 5.8%(9/155) and 1.9%(3/155), respectively. According to ITT analysis, the eradication rate of clarithromycin group, levofloxacin group, furanzolidone group and metronidazole group was 81.5%(53/65), 90.8%(59/65), 93.8%(61/65) and 75.4%(49/65), respectively. And according to PP analysis which was 84.1%(53/63), 92.2%(59/64), 95.3%(61/64) and 79.0%(49/62), respectively. The differences between furanzolidone group and metronidazole group, clarithromycin group were staistcally significant (χITT2=8.509 and 4.561; χPP2=7.592 and 4.323, all P<0.05). There was no statistical significance in the H. pylori eradication rate between resistant strains and sensitive strains of each group. Conclusion Bismuth-based quadruple therapy can overcome antibiotic resistance, the eradication rate of protocal with furanzolidone is higher and with good safety, which can be the first-line treatment for H. pylori eradication. Key words: Helicobacter pylori; Drug resistance, multiple; Bismuth; Quadruple therapy