헬리코박터 파일로리 제균에서 항생제 감수성 기반 맞춤 삼제요법과 경험적 삼제요법의 제균 효과 비교 = The Efficacy of Susceptibility-Guided Tailored Triple Therapy Is Superior to that of Empirical Triple Therapy for Helicobacter pylori Eradication

다국어 초록 (Multilingual Abstract)

Background & Aims: Helicobacter pylori eradication is a critical strategy for preventing gastric cancer in high-incidence regions. However, empirical triple therapy comprising clarithromycin and amoxicillin has exhibited declining efficacy with increasing antibiotic resistance. This study aimed to compare empirical and susceptibility-guided tailored triple therapy and explore the optimal treatment duration and minimum inhibitory concentration (MIC) threshold for clarithromycin and amoxicillin.

Methods: We retrospectively analysed 807 patients who received triple therapy comprising proton pump inhibitors, clarithromycin and amoxicillin between 2020 and 2024 at tertiary hospitals in Korea. Patients received either empirical or susceptibility-guided tailored therapy. The outcomes of the intention to treat (ITT) and per protocol (PP) populations were assessed.

Results: Tailored triple therapy was administered to 449 patients and empirical triple therapy was administered to 358 patients. Eradication rates of patients in the tailored triple therapy group were higher than those of patients in the empirical triple therapy group (ITT: 92.9% vs. 69.3%, p<0.001; PP: 93.7% vs. 69.7%, p<0.001). In the tailored triple group, eradication rates were 91.4% with 7 days, 96.8% with 10 days, and 95.7% with 14 days of treatment; these results were consistently higher than 90% without significant differences (p=0.107). Overall eradication rates of regimens exceeded 85% across all resistance categories.

Conclusions: Tailored triple therapy comprising proton pump inhibitor, clarithromycin and amoxicillin consistently achieved eradication rates higher than 90% across all treatment durations, whereas empirical triple therapy failed to achieve acceptable efficacy. The accumulation of more data regarding tailored therapy based on the MIC may allow shortened treatment durations and improved patient compliance and safety.

목차 (Table of Contents)

• Abstract i
• List of tables v
• List of figures vi
• Introduction 1
• Materials and Methods 3
• 1 Study design and setting 3
• 2 Study population 5
• 3 Data collection 6
• 4 Definition 7
• 5 Specimen collection and H. pylori culture 7
• 6 Antibiotic susceptibility testing 8
• 7 Analytic populations 9
• 8 Statistical analysis 9
• Result 10
• 1 Baseline characteristics of enrolled patients 10
• 2 Comparision of eratication rates with empirical and tailored triple therapy 13
• 3 Eradication Rates According to Treatment Durations in the PP Population Who Received Tailored Triple Therapy 13
• 4 Eradication Rates According to Antibiotic Susceptibility in the PP Population Who Received Tailored Triple Therapy 15
• 5 Effect of Amoxicillin Susceptibility and Treatment Durations on Eradication Outcomes of the PP Population Who Received Tailored Triple Therapy 17
• 6 Eradication Rates According to MIC Distributions in the PP Population Who Received Tailored Triple Therapy 19
• 7 Intragastric Heteroresistance of the Antrum and Corpus in Patients Who Received Tailored Triple Therapy 22
• 8 Eradication Rates According to Antibiotic Resistance Profiles in Patients Who Received Other Tailored Regimen 24
• Discussion 28
• Conclusion 33
• Reference 34
• 국문초록 38