{"entity":{"id":"idea-prev-hpylori-stool-resistance-guided","kind":"idea","name":"Antibiotic-resistance testing from a stool sample before treating H. pylori","aka":[],"tldr":"H. pylori eradication often fails because of antibiotic resistance. A stool DNA test showing which antibiotics will work would raise cure rates and protect antibiotics.","summary":"Helicobacter pylori eradication often fails because of antibiotic resistance, so this idea runs a stool PCR for 23S rRNA and gyrA resistance mutations before treatment and tailors first-line therapy accordingly in mass eradication programmes. Clarithromycin resistance is now common in many regions, tailored-therapy RCTs already show superiority over empirical treatment, and stool testing removes the need for endoscopy. Endpoints are eradication rate and antibiotic consumption, with the aim of higher cure rates and less macrolide use, protecting antibiotics as well as preventing gastric cancer. The test is an RCT of 5,000 patients within a population programme. At early-clinical maturity it addresses the bottleneck Prevention we already have is not deployed.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Prevention we already have is not deployed): Islami et al., Proportion of cancer attributable to modifiable risk factors (CA 2018)","url":"https://doi.org/10.3322/caac.21440"}],"tags":[],"related":[],"cancers":["gastric"],"sections":["prevention"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-prevention-adoption"],"keyPapers":["paper-islami-ca-cancer-j-clin"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Resistance-guided therapy achieves at least 90% eradication versus about 75% for empirical therapy and reduces macrolide use by at least 40%.","rationale":"Tailored-therapy RCTs already show superiority; stool PCR removes the need for endoscopy.","test":"Run an RCT of 5,000 patients within a population programme.","maturity":"early-clinical","actor":"clinic","cost":"medium","horizonYears":3},"route":"/ideas/idea-prev-hpylori-stool-resistance-guided/","neighbours":{"cancer":[{"id":"gastric","kind":"cancer","name":"Gastric & gastro-oesophageal junction cancer","route":"/cancers/gastric/"}],"section":[{"id":"prevention","kind":"section","name":"Prevention & Risk","route":"/fronts/prevention/"}],"bottleneck":[{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/"}],"paper":[{"id":"paper-islami-ca-cancer-j-clin","kind":"paper","name":"Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States","route":"/key-papers/paper-islami-ca-cancer-j-clin/"}]}}