AUTHOR=Byambajav Tsogt-Ochir , Bira Namdag , Choijamts Gotov , Davaadorj Duger , Gantuya Boldbaatar , Sarantuya Tserenchimed , Sarantuya Gidaagaya , Enkhtsetseg Altangerel , Erdenetsogt Dungubat , Battulga Adiyasuren , Tserentogtokh Tegshee , Matsuhisa Takeshi , Yamaoka Yoshio , Oyuntsetseg Khasag 

TITLE=Initial Trials With Susceptibility-Based and Empiric Anti-H. pylori Therapies in Mongolia

JOURNAL=Frontiers in Pharmacology

VOLUME=10

YEAR=2019

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2019.00394

DOI=10.3389/fphar.2019.00394

ISSN=1663-9812

ABSTRACT=<p><bold>Background:</bold> Mongolia has a high prevalence of <italic>Helicobacter pylori</italic> infection and gastric cancer. We conducted a prospective, randomized, single-blind study to evaluate the efficacy of common regimens in Mongolia and to obtain specimens for susceptibility testing.</p><p><bold>Methods:</bold> Empiric treatments: 270 patients with confirmed <italic>H. pylori</italic> infection were randomized to receive 10 days clarithromycin-triple therapy (Clari-TT) (<italic>n</italic> = 90), modified bismuth quadruple therapy (M-BQT) (<italic>n</italic> = 90), or sequential therapy (ST) (<italic>n</italic> = 90). A second group of 46 patients received susceptibility-based Clari-TT. <italic>H. pylori</italic> was cultured from 131 patients and susceptibility testing was performed. <italic>H. pylori</italic> eradication was confirmed by stool antigen 4 weeks after the therapy.</p><p><bold>Results:</bold> Intention-to-treat (ITT) analysis cure rates were 71.1% (95% CI = 61.7–80.5%) for Clari-TT, 87.8% (95% CI = 81–94.6%) for M-BQT, 67.8% (95% CI = 58.1–77.5%) for ST vs. 89.1% (95% CI = 86–98.2%) for susceptibility-based Clari-TT. Per-protocol (PP) analysis results for these therapies were 72.7% (63.4–82%), 89.8% (83.5–96.1%), 68.5% (58.8–78.2%), and 97.6% (89.5–99.8%), respectively. Among 131 cultured <italic>H. pylori</italic>, resistance rates to amoxicillin, clarithromycin, and metronidazole were 8.4, 37.4, and 74%, respectively.</p><p><bold>Conclusion:</bold> In Mongolia, the prevalence of <italic>H. pylori</italic> resistance is high requiring bismuth quadruple therapy or susceptibility-based therapy to obtain acceptable cure rates.</p>