We had a brilliant lecture given to our group by Dr. Benjamin Gold. I have had the good fortune of getting to know Ben and working alongside Ben for more than 15 years. Most readers of this blog are very familiar with Dr. Gold who is a leader in our field.
My notes below may contain errors in transcription and in omission.
Guidelines:
- Bismuth-based quadruple therapy recommended when antimicrobial sensitivity testing (AST) is not available
- Routine use of CLO test is NOT recommended during endoscopy
- Routine testing for H pylori is NOT recommended for children with recurrent abdominal pain
- Stool PCR testing is NOT recommended
- Test for cure should be done at 6-8 weeks after completion of treatment
During endoscopy at CHOA in which H pylori is suspected, complete a microbiology form and ask for a culture to arrange for resistance testing. Submit a sample (or multiple) in a sterile tube/cup. Completed results will include clarithromycin sensitivity. Additional testing for other antibiotic resistance can be requested subsequently. Testing can be done with paraffin block as well.
Related blog posts:
- Give the Right Dose (for H pylori) -It Works Better!
- Helicobacter Pylori Stool Susceptibility in Children –How Good Is It?
- Understanding FDA Approval of Vonoprazan-Based Therapies for Helicobacter Pylori
- Synergistic Dangers: Helicobacter Pylori and Cancer Genes
- AGA: Best Practice Advice for Refractory H pylori
- Treating Helicobacter Pylori Lowers The Risk of Gastric Cancer
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gutsandgrowth 
What is the recommended method of antibiotic susceptibility testing, which is easily accessible and covered by insurance in the USA? and is this possible without invasive biopsies?
As per my recollection, this was not covered during this lecture. Stool susceptibility testing is available at several labs (see related links). However, it would not be easy to assure that this testing is covered by insurance. As you know, there are lots of different insurance plans and trying to know which cover what is never straightforward. In our endoscopy unit and at the hospital endoscopy unit, we do have the capability of getting susceptibility testing (though this can take 1-2 weeks for the results.
Seems like quadruple therapy would be the standard of care until susceptibility testing really becomes readily available and reliable. Even the send out option (I believe often goes to Mayo) often comes back as unable to grow out H. pylori. Maybe Dr. Gold has a secret on this AST.