Susceptibility-Guided Therapy for Helicobacter Pylori Infection Treatment

Study Overview
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Brief Summary
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This multicenter randomized controlled clinical trial was conducted to compare the eradication efficacy and health economic benefits of individualized regimens based on HP drug resistance mutation gene detection (multiple PCR method), individualized regimens based on HP traditional drug sensitivity testing (E-test method) and empirical regimens in the Helicobacter pylori treatment.

Detailed Description
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This multicenter randomized controlled clinical trial was conducted to compare the eradication efficacy and health economic benefits of individualized regimens based on HP drug resistance mutation gene detection (multiple PCR method), individualized regimens based on HP traditional drug sensitivity testing (E-test method) and empirical regimens in the treatment of Helicobacter pylori in patients with chronic gastritis. This study will compare the efficacy of individualized and empirical drug sensitivity regimens, and conduct cost-effectiveness analysis to provide pharmacoeconomic guidance for clinical decision-making. At the same time, it will provide reference for the reasonable pricing of H.pylori drug sensitivity test and considering the health benefits brought by its inclusion in medical insurance.

Official Title
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Clinical Efficacy and Health Economic Evaluation of Susceptibility-Guided Therapy for Helicobacter Pylori Infection Treatment：Multicenter Randomized Controlled Study

Conditions
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Helicobacter Pylori Infection

Intervention / Treatment
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* Drug: Esomeprazole
* Drug: Bismuth potassium citrate
* Drug: Metronidazole
* Drug: Clarithromycin
* Drug: Levofloxacin
* Drug: Amoxicillin
* Drug: Tetracycline


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participate in the trial voluntarily, fully understand the trial, and sign the informed consent form (ICF). 18-75 years old on the day of signing the ICF. Helicobacter pylori infection confirmed by 13C-urea breath test or rapid urease test. Exclusion Criteria: Patients with severe heart, lung, kidney, liver, blood, nerve, endocrine, and psychiatric diseases. Subjects or guardians refused to participate in the trial. Alcohol and/or drugs Abuse (addiction or dependence) or poor compliance with doctor's judgment. Have taken antibiotics, bismuth, proton pump inhibitors or Chinese traditional medicine 4 weeks before treatment. Pregnant or lactating women. Active peptic ulcer. allergic to drugs used in the trial. any other circumstances that are not suitable for recruitment.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Genotypic resistance guided therapy<br>After Helicobacter pylori drug resistance mutation gene detection, according to genotypic antibiotic resistance pattern of each one, give esomeprazole 20mg bid and bismuth potassium citrate 0.6 g bid, combined two sensitive antibiotics of Amoxicillin, tetracycline,clarithromycin, metronidazole,and levofloxacin. All regimens will be given for 14 days. | Drug: Esomeprazole<br>* 20mg bid<br>Drug: Bismuth potassium citrate<br>* 0.6g bid<br>Drug: Metronidazole<br>* 0.4g qid<br>Drug: Clarithromycin<br>* 0.5g bid<br>Drug: Levofloxacin<br>* 0.5g qd<br>Drug: Amoxicillin<br>* 1g bid<br>Drug: Tetracycline<br>* 0.5g qid<br>|
| Experimental: Phenotypic resistance guided therapy<br>After antimicrobial susceptibility testing of Helicobacter pylori from biopsy samples, according to phenotypic antibiotic resistance pattern of each one, give esomeprazole 20mg bid and bismuth potassium citrate 0.6 g bid, combined two sensitive antibiotics of Amoxicillin, tetracycline,clarithromycin, metronidazole,and levofloxacin. All regimens will be given for 14 days. | Drug: Esomeprazole<br>* 20mg bid<br>Drug: Bismuth potassium citrate<br>* 0.6g bid<br>Drug: Metronidazole<br>* 0.4g qid<br>Drug: Clarithromycin<br>* 0.5g bid<br>Drug: Levofloxacin<br>* 0.5g qd<br>Drug: Amoxicillin<br>* 1g bid<br>Drug: Tetracycline<br>* 0.5g qid<br>|
| Active Comparator: Empiric therapy<br>Esomeprazole 20 mg bid, bismuth potassium citrate 0.6 g bid, metronidazole 0.4 g qid, and Amoxicillin 1.0 g bid (no penicillin allergy) OR tetracycline 0.5g qid (penicillin allergy) for 14 days | Drug: Esomeprazole<br>* 20mg bid<br>Drug: Bismuth potassium citrate<br>* 0.6g bid<br>Drug: Metronidazole<br>* 0.4g qid<br>Drug: Amoxicillin<br>* 1g bid<br>Drug: Tetracycline<br>* 0.5g qid<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Eradication rate of Helicobacter pylori | Eradication of Helicobacter pylori was defined as negative result of urea breath test (<4‰ cut-off value). | 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Eradication rate of Helicobacter pylori resistant strains | Eradication of Helicobacter pylori was defined as negative result of urea breath test (<4‰ cut-off value). The antibiotic resistant strains were assessed using the E test method. | 6 weeks | 
| Eradication rate of Helicobacter pylori susceptible strains | Eradication of Helicobacter pylori was defined as negative result of urea breath test (<4‰ cut-off value). The antibiotic susceptible strains were assessed using the E test method. | 6 weeks |