Effectiveness of Susceptibility-Guided Therapy for Helicobacter pylori Infection: A Retrospective Analysis by Propensity Score Matching

Purpose: This study evaluates and compares the eradication rates of Helicobacter pylori (H. pylori) achieved through susceptibility- guided therapy (SGT) based on resistance genotyping and empirical therapy (ET). Patients and Methods: A retrospective study was conducted at Beijing Chaoyang Hospital (2021-2023) on patients with H. pylori infection receiving initial eradication therapy. Resistance genotypes for clarithromycin and levofloxacin were identified using fluorescent PCR of gastric biopsy samples. Patients underwent a 14-day bismuth-containing quadruple therapy (BQT) and were evaluated via the C13 urea breath test (UBT). Based on genotyping or clinical judgment, 550 patients were assigned to SGT (n = 125) or ET (n = 425). The SGT group received personalized treatment based on genotype testing results, avoiding the use of antibiotics to which the bacteria were resistant. The ET group received the standard bismuth-containing quadruple therapy (BQT). Additionally, 29 ET patients underwent follow-up genotypic testing and eradication rates were analyzed retrospectively. Results: SGT achieved higher eradication rates than ET (ITT: 94.4% vs 86.1%, P = 0.012; PP: 95.2% vs 87.6%, P = 0.016). In levofloxacin-resistant strains, SGT showed significantly higher eradication rates in the PP analysis (95.7% vs 50.0%, P = 0.049). Conclusion: SGT exhibited remarkably superior eradication rates, notably in levofloxacin-resistant strains, proposing a compelling alternative for the treatment of H. pylori, particularly in instances of antimicrobial resistance.