ideasIdea
Antibiotic-resistance testing from a stool sample before treating H. pylori
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.
Clarithromycin resistance exceeds 30% in many regions, and molecular resistance testing on stool (23S rRNA, gyrA mutations) is feasible. Propose PCR-guided first-line therapy in mass eradication programmes, with eradication rate and antibiotic consumption as endpoints.
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.
What would test it
Run an RCT of 5,000 patients within a population programme.
Maturity
early clinical
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks
- Prevention we already have is not deployed · Around four in ten cancers are preventable with tools we already own: vaccines, tobacco control, weight, alcohol, sun and infection control.