For medication administration, there are five “rights” that are needed for optimal results:
- Right drug
- Right dose
- Right route (e.g., oral, intravenous, topical)
- Right patient
- Right time
The recent article below highlights the fact that the “right drug” for H pylori can be dependent on resistance patterns. Previous articles (see below) have shown that the right dose is equally-important to improve cure rates.
C Chan et al. J Pediatr Gastroenterol Nutr. 2025;81:1133–1141. Antimicrobial susceptibility-guided treatment is superior to empiric therapy for Helicobacter pylori infection in children
Methods: Retrospective study with 218 children who had histologically-proven H pylori infection. Susceptibility-guided treatment (SGT) was given to 123 and empiric therapy (ET) to 95. Testing for susceptibility was via a send-out assay to an outside specialty laboratory (Mayo Clinic Laboratories).
Key findings:
- Eradication success was significantly higher in the SGT group (89.4%,110/121) compared to the ET group (70.2%, 66/94) (p < 0.001).
- Amoxicillin resistance was strongly associated with failure (27.3% vs. 0.9%, p = 0.002), as was dual clarithromycin-metronidazole resistance (36.4% vs. 8.2%, p = 0.018).
My take: This study shows the huge improvement when therapy is adjusted based on known susceptibility.
Related blog posts:
- Give the Right Dose (for H pylori) -It Works Better!
- Dr. Benjamin Gold: 2024 Pediatric H pylori Guidelines (Part One)
- Dr. Benjamin Gold: 2024 Pediatric H pylori Guidelines (Part 2)
- Excellent Review of H Pylori in Children Plus One on Healthy Aging
- Brief Updates: H pylori Resistance Rates, VEDOKIDS, Increasing Bariatric Surgery in Kids
Also, more on changes to CDC website:
Benjamin Mazer, The Atlantic; 11/21/25: Open Access! Do Childhood Vaccines Cause Tornadoes? It hasn’t been ruled out (Related blog post: CDC Website Changed to Include False Claims About Autism and Vaccines)
gutsandgrowth 
How often does the susceptibility test come back without a result? Unable to grow out pathogen?
From the study senior author, Dr. Bonilla: “We ultimately partnered with a specialty lab, Mayo Laboratories for our H pylori susceptibility testing. Another important point is establishing clear communication with the lab. We now integrate results directly into EPIC so physicians see when a culture is positive and susceptibilities are pending. Final susceptibility reports often take 5–7 business days. In my experience, when we take the time to explain this to families, they are comfortable waiting in order to receive the most effective antibiotics. In the meantime, patients can start a PPI if needed for symptomatic relief.
At present, our culture growth rate is approximately 90%. For the remaining 10% without susceptibility results, we are working to implement a reflex molecular pathway using PCR for detection and, when positive, next-generation sequencing for susceptibilities on FFPE samples. We are also exploring the use of stool samples for the same molecular testing. Our goal is to ensure that all patients receive targeted, effective therapy even when culture is unsuccessful. Broader adoption of molecular techniques will be an important part of the future of pediatric H. pylori care. We are actively generating data to support clinical usefulness, expand access, and hopefully facilitate insurance coverage.”