A128 ANTIBIOTIC RESISTANCE DOES NOT FULLY EXPLAIN <i>HELICOBACTER PYLORI</i> TREATMENT FAILURES
Bibliographic record
Abstract
Abstract Background Most treatment failures of Helicobacter pylori are attributed to antibiotic resistance or patient nonadherence. Commonly used 1st-line treatment regimens include 14 day concomitant [proton pump inhibitor(P), amoxicillin(A), metronidazole(M), and clarithromycin(C):PAMC], or bismuth-based quadruple therapy [P, Bismuth(B), M, and tetracycline(T):PBMT]. Levofloxacin(L)-based PAL is also suggested for 14 days and rifabutin(R)-based PAR for 10 days. Analyses of data on the frequency of treatment failures in antibiotic sensitive cases are scarce. Aims To determine the proportion of H. pylori treatment failures not explained by antibiotic resistance. Methods Cultures of H. pylori positive patients (by histology, urea breath test, or stool antigen test) at the University of Alberta Hospital in Edmonton, Canada were assessed for resistance by E-test according to EUCAST thresholds to C, M, A, T, and L measuring minimum inhibitory concentrations. Results There were 68 positive cultures from 64 individuals in 292 cases. Treatment adherence was high in patients with follow-up (FU) testing available. Median number of antibiotic regimens received prior to culture was 2 (IQR 0-3). In patients not previously treated, overall cure rate was 10/17 (59%) vs 21/47 (45%) for those who had been previously treated (p=.32). Summary data on outcomes are shown in Fig 1. Clarithromycin: 14/63 (22%) cases had C-sensitive cultures. Regimens containing C were successful in 5/8 (63%), failures were PAC(1), Sequential therapy (1), and PMC(1). Of C-sensitive cases, 5/14 (36%) had been previously treated with C: further treatment success was 1/2 with PAR and 0/1 with PAL. Metronidazole: 25/52 (48.0%) cases were M-sensitive: 11 cases were treated with M-containing regimens. 80% (8/10) were successfully treated with PBMT or PAMC, 1 case failed. Success with non-M regimens was 67% (4/6) with PAR and 1/2 with PAL. PBMT was successful in 60% (3/5) of M-sensitive patients with prior M-exposure. 43% (22/51) of cases had dual resistance to C and M. In 5 cases who were sensitive to both C and M, 60% (3/5) were cured with PAMC, 1 declined treatment and 1 was lost to FU. Levofloxacin: 22/57 (39%) cases were L-sensitive of which 41% (9/22) had been previously treated with PAL. Successful treatment with PAL was 67% (4/6) in L-sensitive cases. There were no cases of T-resistance (0/66). Borderline A-resistance was observed in 9% (4/46) of cases. Conclusions H. pylori treatment failures are not fully explained by antibiotic resistance. A substantial proportion (27-41%) of patients failed despite being sensitive to the antibiotics used (C, M, L). M resistance can be partially overcome with combination treatment. Resistance to A and T is rare. Clinical history including adherence is an important complement to antibiotic resistance testing in H. pylori, especially to determine previous C exposure. Figure 1: Treatment success in confirmed cases with antibiotic-sensitive H. pylori cultures. Abbreviations: PPI, proton pump inhibitor; PAMC, PPI-amoxicillin-metronidazole-clarithromycin; PAC, PPI-amoxicillin-clarithromycin; PMC, PPI-metronidazole-clarithromycin; PAR, PPI-amoxicillin-rifabutin; PAL, PPI-amoxicillin-levofloxacin; PBMT, PPI-bismuth-metronidazole-tetracycline; PAM, PPI-amoxicillin-metronidazole; PBAT, PPI-bismuth-amoxicillin-tetracycline Funding Agencies None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".