Susceptibility-guided Vs. Empirical 10-day Quadruple Treatment for -infected Patients: A Prospective Clinical Trial of First-line Therapy

Background: The increasing antimicrobial resistance of ) has resulted in a fall in cure rates. We aimed to assess the effectiveness of first-line susceptibility-guided therapy and furazolidone-based quadruple therapy for -infected patients.

Methods: Subjects with -infection were randomly assigned to either 10-day susceptibility-guided treatment or empiric treatment in a 2:1 ratio. Susceptibility-guided therapy was based on susceptibility to clarithromycin, and patients with susceptible strains received clarithromycin 500 mg twice daily and otherwise minocycline 100 mg twice a day was administered. Patients in the empiric therapy group was treated with furazolidone 100 mg twice a day. During treatment, all patients were given esomeprazole 20 mg twice daily, colloidal bismuth pectin 200 mg twice daily, and amoxicillin 1 g twice daily.

Results: A total of 248 patients were screened and 201 were finally included. Empiric and susceptibility-guided regimens were both successful with per-protocol eradication rates of 90.5% (57/63) vs. 88.5% (108/122) ( = 0.685) and intent-to-treat eradication rates of 85.1% (57/67) vs. 80.6% (108/134) ( = 0.435). No significant difference in eradication rates were observed among the furazolidone group, clarithromycin group and minocycline group.

Conclusion: Both susceptibility-guided therapy and quadruple therapy containing furazolidone can achieve good eradication rates. For population with a high rate of resistance, quadruple therapy containing furazolidone and bismuth may be a more practical choice for first-line treatment.