Types of 23S Ribosomal RNA Point Mutations Affecting Helicobacter pylori Eradication Rates in Clarithromycin-Based Triple Therapy

Abstract

Objectives: The A2142G and A2143G mutations in the 23S ribosomal ribonucleic acid (rRNA) of <i>Helicobacter pylori</i> are the most common mutations associated with clarithromycin resistance. This study aimed to determine the differences in <i>H. pylori</i> eradication rates in patients infected with bacteria carrying the A2142G and A2143G mutations who were treated with clarithromycin-based triple therapy. Methods: Data from a previous randomized controlled trial were analyzed retrospectively. Eradication rates were compared based on the presence of <i>H. pylori</i> carrying the A2142G and A2143G mutations. A meta-analysis was also conducted of relevant studies containing data regarding patients who received clarithromycin-based therapy due to infections with <i>H. pylori</i> harboring 23S rRNA mutations. Results: No significant difference was observed in <i>H. pylori</i> eradication rates between patients infected with wild-type bacteria (95.7% [44/46]) compared with those infected with bacteria carrying the A2142G mutation (100.0% [3/3]; <i>p</i>>0.9). However, the eradication rate was significantly lower for patients infected with bacteria carrying the A2143G mutation (16.7% [1/6]; <i>p</i><0.001) than for those infected with wild-type bacteria or bacteria with the A2142G mutation (100.0% [3/3]; <i>p</i>=0.048). In the meta-analysis, the between-group comparisons yielded similar results. Although patients infected with bacteria having the A2142G mutation exhibited no significant risk difference (RD) for eradication compared with those infected with wild-type bacteria (RD=-0.05 [-0.18 to 0.08]; I²=0%; <i>p</i>=0.42), those infected with bacteria having the A2143G mutation demonstrated a lower <i>H. pylori</i> eradication rate compared with patients infected with either wild-type (RD=0.72 [0.64–0.80]; I²=0%; <i>p</i><0.001) or A2143G mutant bacteria (RD=0.76 [0.61–0.91]; I²=0%; <i>p</i>< 0.001). Conclusions: The A2143G mutation may play a more significant role in clarithromycin triple therapy <i>H. pylori</i> eradication failure than does the A2142G mutation. Additionally, <i>H. pylori</i> strains with the A2142G mutation can be treated effectively with clarithromycin-based triple therapy.