Evaluation of Culture and Sensitivity Guided Antibiotic Selection in Eradication of Helicobacter pylori

Abstract Background Helicobacter pylori exhibits antibiotic resistance with regional differences. Antibiotics resistance is the main cause of eradication failure in H. pylori infection, thus our study aimed to evaluate the efficiency of standard triple therapy vs. Antibiotic -culture with susceptibility-based therapy and success rate of each in helicobacter pylori eradication. Methods This study was conducted on 100 patients with dyspepsia undergoing Upper GI Endoscopy in Gastroenterology department at Ain shams university hospital in the period between june2018 and june2019, the volunteered patients were divided into groups A and B. Group A patients received 2 weeks of pantoprazole 40 mg bid +two Antibiotics according to each patient’s result of culture and sensitivity, while Group B patients received 2 weeks of standard triple therapy PPI 40 mg bid + Amoxicillin 1 g bid + Clarithromycin 500 mg bid Results that patients of group A according to their culture and sensitivity results showed Significant increase in number of isolates sensitive to levofloxacin (26) than those resistant to it (14) with p-value 0.1(HS), Significant number of isolates resistant to clarithromycin (36) than those sensitive to it (14) with p-value o.011 and (HS), also Significant increase in number of isolate resistant to amoxicillin (40) than those sensitive to it (10) with p-value 0.003(HS) and finally significant increase in number of isolate resistant to metronidazole (40) than those sensitive to it (10) with p -value 0.003(HS). H. pylori results 4 weeks post treatment in groups A and B showed that there was a Significant number of positive helicobacter pylori patients 4 weeks post tr eatment in group B (30) than in group A (7) with p- value <0.01 (HS) and Significant number of negative helicobacter pylori patients 4 weeks post treatment in group A(43) than in group B (20) with p- value <0.01 (HS). Conclusion 43 of group (A) patients (86%) showed successful helicobacter pylori eradication after culture guided antibiotic therapy. Only 20 of group (B) patients (60%) showed successful h. pylori eradication after standard triple therapy. The study showed high resistant rates of h. pylori to clarithromycin and amoxicillin and metronidazole and gradually increasing resistance against levofloxacin. Countries like Egypt seem to have a high clarithromycin resistance, and a large-scale clinical trial is needed to choose the first -line therapy for eradication of H. pylori infection.