{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T21:46:02Z","timestamp":1790891162764,"version":"4.1.0"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T00:00:00Z","timestamp":1701302400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Japan Agency for Medical Research and Development (AMED) [e-ASIA JRP]"},{"name":"Thailand Science Research and Innovation Fundamental Fund"},{"name":"Bualuang ASEAN Chair Professorship at Thammasat University"},{"name":"Center of Excellence in Digestive Diseases, Thammasat University, Thailand"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p><jats:italic>Helicobacter pylori<\/jats:italic> treatment failure remains a challenging problem. This study aimed to identify predictive factors for successful eradication in patients following treatment failures.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This was a retrospective cohort study. This study included 1,050 dyspeptic patients diagnosed with <jats:italic>H<\/jats:italic>. <jats:italic>pylori<\/jats:italic> infection at tertiary care center in Thailand between March 2014 and October 2021. Patients\u2019 demographic data, endoscopic findings, <jats:italic>H<\/jats:italic>. <jats:italic>pylori<\/jats:italic> culture, antimicrobial susceptibility testing (AST), treatment regimens and outcomes were analysed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of 1,050 patients with <jats:italic>H<\/jats:italic>. <jats:italic>pylori<\/jats:italic> infections, 302 (28.7%) experienced treatment failure (mean age 58.4 years; 44.7% males). AST was performed in 192. Resistance was observed for metronidazole (43.2%), levofloxacin (33.9%), clarithromycin (24%), and amoxicillin (2.1%). There was no tetracycline resistance. Multidrug-resistance (MDR) was significantly more common following treatment failure (45.5% vs. 15.7%, p&lt;0.001). Baseline characteristics were similar between treatment successes and failures. Eradication rates after first-line and second-line regimens were 71.2% and 54.5%, respectively. Medication nonadherence [<jats:bold>OR 36.6 (95%CI 8.65\u2013155.03, p&lt;0.001)<\/jats:bold>] and MDR [<jats:bold>OR 4.49 (95%CI 2.29\u20138.81, p&lt;0.001)<\/jats:bold>] were associated with treatment failure. Over time, resistance increased for metronidazole, levofloxacin, and clarithromycin, while eradication rates with triple therapy declined. Tailored antibiotic therapy [<jats:bold>OR 4.92 (95%CI 1.61\u201314.99, p = 0.005<\/jats:bold>)] and a regimen including 4-times-daily dosing of amoxicillin (2 grams\/day) [<jats:bold>OR 3.05 (95%CI 1.10\u20138.41, p = 0.032)<\/jats:bold>] were significantly associated with treatment success after first-line failure. Eradication rates when using tailored therapy and 4-times-daily dosing of amoxicillin (2 grams\/day) were 91.1% and 89.4%, respectively. Performing AST before first-line therapy resulted in the highest cure rates. AST performed after multiple treatment failures was also associated with higher eradication rates compared with the group without AST (94.4% vs. 50%,p = 0.008).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>AST either before or after treatment failure correlated with a higher proportion of successful eradication. Nonadherence and the MDR infections predicted treatment failure. Tailored therapy and 4-times-daily dosing of <jats:italic>amoxicillin<\/jats:italic> after treatment failure were likely to be successful.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0294403","type":"journal-article","created":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T19:03:07Z","timestamp":1701370987000},"page":"e0294403","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":24,"title":["Management of Helicobacter pylori treatment failures: A large population-based study (HP treatment failures 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