Commentary: Tailored therapy for Helicobacter pylori eradication: A systematic review and meta-analysis

Ma et al. (2022) published “Tailored therapy for Helicobacter pylori eradication,” a systematic review and meta-analysis suggesting that a tailored therapeutic approach might provide a better eradication success rate than empirical therapeutic methods in the first-line treatment regimen for H. pylori. To be considered a first-line treatment for H. pylori, a regimen must have an eradication rate of at least 80%–85% (Fallone et al., 2016). Therefore, various guidelines for the treatment of H. pylori recommend antibiotic susceptibility testing prior to therapy initiation to maintain high eradication rates (Jones et al., 2017; Kato et al., 2019; Kato et al., 2020; Jung et al., 2021; Romano et al., 2022). In recent guidelines for the treatment of H. pylori, non-bismuth quadruple therapy, sequential or concomitant treatment, and bismuth quadruple therapy is recommended as first-line treatment regimens in areas where clarithromycin (CAM) resistance mutations cause >15% of all cases (Malfertheiner et al., 2017; Liu et al., 2018). However, there are concerns that the inappropriate use of antibiotics may eventually lead to drug resistance. Because the overall H. pylori antibiotic resistance rates for CAM are 17.2% (95%, confidence interval 16.5%–17.9%) (De Francesco et al., 2010), it is necessary to consider performing a CAM resistance test before eradication therapy for H. pylori. OPEN ACCESS