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Xie J, Peng J, Liu D, Zeng R, Qiu J, Shen L, Gong X, Liu D, Xie Y. Treatment failure is a key factor in the development of Helicobacter pylori resistance. Helicobacter 2024; 29:e13091. [PMID: 38780150 DOI: 10.1111/hel.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/11/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Helicobacter pylori eradication failure influences its antibiotic resistance. AIMS This study aimed to evaluate the effect of previous treatment failures on it, including the changes in the antibiotic resistance rates, minimal inhibitory concentration (MIC) distributions, and resistance patterns. MATERIALS AND METHODS This single-center retrospective study included 860 primary isolates and 247 secondary isolates. Antibiotic susceptibility testing was performed for amoxicillin, metronidazole, clarithromycin, levofloxacin, furazolidone, tetracycline, and rifampicin. The demographic data and detailed regimens were collected. RESULTS The primary resistance rates to amoxicillin, metronidazole, clarithromycin, levofloxacin, tetracycline, rifampin, and furazolidone were 5.93%, 83.84%, 28.82%, 26.28%, 0.35%, 1.16%, and 0%, while secondary were 25.10%, 92.31%, 79.76%, 63.16%, 1.06%, 3.19%, and 0%, respectively. The resistance rates to amoxicillin, metronidazole, clarithromycin, and levofloxacin increased significantly with the number of treatment failures accumulated, and showed a linear trend. The proportion of primary and secondary multidrug-resistant (MDR) isolates were 17.79% and 63.16%, respectively. The MIC values of amoxicillin, clarithromycin, and levofloxacin were elevated significantly with medication courses increased. CONCLUSION The prevalence of amoxicillin, clarithromycin, levofloxacin, and metronidazole resistance would increase rapidly following first-line treatment failure, as well as the MIC values of them. Clinicians should pay great attention to the first-line treatment to cure H. pylori infection successfully.
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Affiliation(s)
- Jinliang Xie
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China
| | - Jianxiang Peng
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China
| | - Dingwei Liu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China
| | - Rong Zeng
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China
| | - Jiayu Qiu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China
| | - Liting Shen
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China
| | - Xiaomin Gong
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China
| | - Dongsheng Liu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China
| | - Yong Xie
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi Province, China
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Jearth V, Panigrahi MK. Current paradigms in the management of refractory Helicobacter pylori infection. Indian J Gastroenterol 2023; 42:766-779. [PMID: 37737326 DOI: 10.1007/s12664-023-01448-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/09/2023] [Indexed: 09/23/2023]
Abstract
Helicobacter pylori is the most prevalent chronic bacterial infection, with approximately half of the world's population estimated to be colonized. The World Health Organization (WHO) has classified Helicobacter pylori as a class-I carcinogen. All main society guidelines recommend its eradication in infected individuals. The global trend indicates that eradication rates are decreasing annually and the likelihood of eradication decreases with each unsuccessful therapeutic attempt. Resistance to antibiotics in H. pylori strains is the leading cause for eradication failure. Still, drug resistance and treatment failure may be complex, multi-dimensional and associated with several other factors. Knowledge of these factors can aid in optimizing eradication rates. This review will focus on the factors associated with refractory H. pylori, with a particular emphasis on antibiotic resistance mechanisms and their clinical implications. Also, the most recent literature and recommendations available for determining an appropriate regimen after the failure of the first attempt at eradication will be discussed.
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Affiliation(s)
- Vaneet Jearth
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Manas Kumar Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar, 751 019, India.
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Nista EC, Pellegrino A, Giuli L, Candelli M, Schepis T, De Lucia SS, Ojetti V, Franceschi F, Gasbarrini A. Clinical Implications of Helicobacter pylori Antibiotic Resistance in Italy: A Review of the Literature. Antibiotics (Basel) 2022; 11:antibiotics11101452. [PMID: 36290110 PMCID: PMC9598780 DOI: 10.3390/antibiotics11101452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Helicobacter pylori (H. pylori) resistance to antibiotics has increased worldwide in recent decades, especially to clarithromycin. As a result, the World Health Organization (WHO) identified clarithromycin-resistant H. pylori as a "high priority" pathogen in 2017. As international guidelines recommend empirical therapy as first-line treatment, it is crucial to know local resistance rates and history of antibiotic use to determine the most appropriate first-line antibiotic treatment. Italy is one of the European countries with the highest prevalence of H. pylori infection and the highest percentage of antibiotic-resistant H. pylori. The aim of this review is to summarize all data on H. pylori antibiotic resistance in Italy in order to quantify the current rate and determine the most effective therapeutic approach. The study confirms an elevated level of resistance to clarithromycin, metronidazole, and levofloxacin in Italy. In addition, our results show a satisfactory eradication rate for a bismuth-based regimen when used as first- or second-line treatment. Naive patients are also successfully treated with clarithromycin-based quadruple therapies. Considering the good results of bismuth-based therapy as recovery therapy, this argues for the potential use of clarithromycin quadruple therapy as a first-line treatment.
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Affiliation(s)
- Enrico Celestino Nista
- Department of Medical and Surgical Sciences, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: (E.C.N.); (A.G.); Tel.: +39-0630151 (E.C.N. & A.G.)
| | - Antonio Pellegrino
- Department of Medical and Surgical Sciences, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy
| | - Lucia Giuli
- Department of Medical and Surgical Sciences, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy
| | - Marcello Candelli
- Department of Emergency, Anesthesiological, and Reanimation Sciences, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy
| | - Tommaso Schepis
- Department of Medical and Surgical Sciences, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy
| | - Sara Sofia De Lucia
- Department of Medical and Surgical Sciences, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy
| | - Veronica Ojetti
- Department of Emergency, Anesthesiological, and Reanimation Sciences, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Franceschi
- Department of Emergency, Anesthesiological, and Reanimation Sciences, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: (E.C.N.); (A.G.); Tel.: +39-0630151 (E.C.N. & A.G.)
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Clinical Factors Implicated in Antibiotic Resistance in Helicobacter pylori Patients. Microorganisms 2022; 10:microorganisms10020322. [PMID: 35208776 PMCID: PMC8876575 DOI: 10.3390/microorganisms10020322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 02/01/2023] Open
Abstract
Helicobacter pylori is a common gastric pathogen associated with multiple clinical syndromes, including cancer. Eradication rates of H. pylori remain suboptimal despite the progress made in the past few decades in improving treatment strategies. The low eradication rates are mainly driven by antibiotic resistance of H. pylori. Non-invasive molecular testing to identify patients with antibiotic-resistant H. pylori represents a promising therapeutic avenue, however this technology currently remains limited by availability, costs, and lack of robust validation. Moreover, there is insufficient evidence to demonstrate that resistance-testing-based treatment approaches are superior to appropriately designed empiric strategies. Consensus guidelines recommend use of proven locally effective regimens; however, eradication data are inconsistently generated in several regions of the world. In this review, we describe several clinical factors associated with increased rates of antibiotic resistant H. pylori, including history of previous antibiotic exposure, increasing age, female gender, ethnicity/race, extent of alcohol use, and non-ulcer dyspepsia. Assessment of these factors may aid the clinician in choosing the most appropriate empiric treatment strategy for each patient. Future study should aim to identify locally effective therapies and further explore the clinical factors associated with antibiotic resistance.
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El-Sherbiny GM, Elbestawy MKM. A review – plant essential oils active against Helicobacter pylori. JOURNAL OF ESSENTIAL OIL RESEARCH 2022. [DOI: 10.1080/10412905.2022.2025464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Gamal M. El-Sherbiny
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Nasr City, Egypt
| | - Mahmoud K. M. Elbestawy
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Nasr City, Egypt
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6
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Erkut M, Uzun DY, Kaklıkkaya N, Fidan S, Yoğun Y, Coşar AM, Akyıldız E, Topbaş M, Özgür O, Arslan M. Sociodemographic characteristics and clinical risk factors of Helicobacter pylori infection and antibiotic resistance in the Eastern Black Sea region of Turkey. TURKISH JOURNAL OF GASTROENTEROLOGY 2021; 31:221-233. [PMID: 32343234 DOI: 10.5152/tjg.2020.18631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS The aim of this study was to assess the clinical and sociodemographic risk factors of Helicobacter pylori infection and antibiotic resistance in the eastern Black Sea region of Turkey. MATERIALS AND METHODS In total, 344 patients with dyspeptic symptoms who completed an extended questionnaire were enrolled in the study. Diagnosis of H. pylori infection was made by rapid urease test, histopathological investigation, and culture. Susceptibility of H. pylori strains was assessed by agar dilution (amoxicillin, tetracycline, metronidazole, levofloxacin) and E-test (clarithromycin) methods. RESULTS The H. pylori positivity rate was 40.4% (139/344). Logistic regression analysis indicated that age and the presence of duodenal ulcer were independent risk factors associated with H. pylori positivity (odds ratio (OR): 0.96, 95% CI: 0.93-0.99, p=0.013; OR: 5.42, 95% CI: 1.96-14.98, p=0.001, respectively). Of 104 H. pylori-positive cultures, 43 strains (41%) were susceptible to all antibiotics, whereas 61 (59%) were resistant to at least one antibiotic. H. pylori resistance rates were 34% for levofloxacin, 31.1% for metronidazole, 28.2% for clarithromycin, 2.9% for amoxicillin, and 1% for tetracycline. Logistic regression analysis indicated that previous use of clarithromycin was the only independent risk factor for H. pylori resistance (OR: 6.25, 95% CI: 1.59-24.52, p=0.009). CONCLUSION An understanding of the risk factors for H. pylori positivity and antibiotic resistance in an extended anamnesis may affect treatment choice and facilitate H. pylori eradication. In regions where antibiotic resistance rates are elevated, performing antibiotic susceptibility tests may lead to effective eradication treatment.
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Affiliation(s)
- Murat Erkut
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Doğan Yusuf Uzun
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Neşe Kaklıkkaya
- Department of Medical Microbiology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sami Fidan
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Yaşar Yoğun
- Clinic of Gastroenterology, Gebze Fatih State Hospital, Kocaeli, Turkey
| | - Arif Mansur Coşar
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Esma Akyıldız
- Department of Medical Microbiology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Murat Topbaş
- Department of Public Health, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Orhan Özgür
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Mehmet Arslan
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
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7
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White B, Sterrett JD, Grigoryan Z, Lally L, Heinze JD, Alikhan H, Lowry CA, Perez LJ, DeSipio J, Phadtare S. Characterization of gut microbiome and metabolome in Helicobacter pylori patients in an underprivileged community in the United States. World J Gastroenterol 2021; 27:5575-5594. [PMID: 34588753 PMCID: PMC8433610 DOI: 10.3748/wjg.v27.i33.5575] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/02/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Helicobacter pylori (H. pylori), a bacterium that infects approximately half of the world’s population, is associated with various gastrointestinal diseases, including peptic ulcers, non-ulcer dyspepsia, gastric adenocarcinoma, and gastric lymphoma. As the burden of antibiotic resistance increases, the need for new adjunct therapies designed to facilitate H. pylori eradication and reduce negative distal outcomes associated with infection has become more pressing. Characterization of the interactions between H. pylori, the fecal microbiome, and fecal fatty acid metabolism, as well as the mechanisms underlying these interactions, may offer new therapeutic approaches.
AIM To characterize the gut microbiome and metabolome in H. pylori patients in a socioeconomically challenged and underprivileged inner-city community.
METHODS Stool samples from 19 H. pylori patients and 16 control subjects were analyzed. 16S rRNA gene sequencing was performed on normalized pooled amplicons using the Illumina MiSeq System using a MiSeq reagent kit v2. Alpha and beta diversity analyses were performed in QIIME 2. Non-targeted fatty acid analysis of the samples was carried out using gas chromatography-mass spectrometry, which measures the total content of 30 fatty acids in stool after conversion into their corresponding fatty acid methyl esters. Multi-dimensional scaling (MDS) was performed on Bray-Curtis distance matrices created from both the metabolomics and microbiome datasets and a Procrustes test was performed on the metabolomics and microbiome MDS coordinates.
RESULTS Fecal microbiome analysis showed that alpha diversity was lowest in H. pylori patients over 40 years of age compared to control subjects of similar age group. Beta diversity analysis of the samples revealed significant differences in microbial community structure between H. pylori patients and control subjects across all ages. Thirty-eight and six taxa had lower and higher relative abundance in H. pylori patients, respectively. Taxa that were enriched in H. pylori patients included Atopobium, Gemellaceae, Micrococcaceae, Gemellales and Rothia (R. mucilaginosa). Notably, relative abundance of the phylum Verrucomicrobia was decreased in H. pylori patients compared to control subjects. Procrustes analysis showed a significant relationship between the microbiome and metabolome datasets. Stool samples from H. pylori patients showed increases in several fatty acids including the polyunsaturated fatty acids (PUFAs) 22:4n6, 22:5n3, 20:3n6 and 22:2n6, while decreases were noted in other fatty acids including the PUFA 18:3n6. The pattern of changes in fatty acid concentration correlated to the Bacteroidetes:Firmicutes ratio determined by 16S rRNA gene analysis.
CONCLUSION This exploratory study demonstrates H. pylori-associated changes to the fecal microbiome and fecal fatty acid metabolism. Such changes may have implications for improving eradication rates and minimizing associated negative distal outcomes.
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Affiliation(s)
- Brian White
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ 08103, United States
| | - John D Sterrett
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, United States
| | - Zoya Grigoryan
- Department of Internal Medicine, Lenox Hill Hospital, NYC, NY 10075, United States
| | - Lauren Lally
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19107, United States
| | - Jared D Heinze
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, United States
| | - Hyder Alikhan
- Department of Biological Sciences, Rowan University, Glassboro, NJ 08028, United States
| | - Christopher A Lowry
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, United States
| | - Lark J Perez
- Department of Chemistry and Biochemistry, Rowan University, Glassboro, NJ 08028, United States
| | - Joshua DeSipio
- Department of Gastroenterology, Cooper University Hospital, Camden, NJ 08103, United States
| | - Sangita Phadtare
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ 08103, United States
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Egli K, Wagner K, Keller PM, Risch L, Risch M, Bodmer T. Comparison of the Diagnostic Performance of qPCR, Sanger Sequencing, and Whole-Genome Sequencing in Determining Clarithromycin and Levofloxacin Resistance in Helicobacter pylori. Front Cell Infect Microbiol 2020; 10:596371. [PMID: 33392106 PMCID: PMC7773895 DOI: 10.3389/fcimb.2020.596371] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022] Open
Abstract
Helicobacter pylori antibiotic resistance is increasing worldwide, emphasizing the urgent need for more rapid resistance detection prior to the administration of H. pylori eradication regimens. Macrolides and fluoroquinolones are widely used to treat H. pylori. In this study, we aimed to compare the diagnostic performance of A) 23SrDNA qPCR (with melting curve analysis) and an in-house developed gyrA qPCR followed by Sanger sequencing with a commercial IVD-marked hybridization probe assay (for 23SrDNA and gyrA) using 142 gastric biopsies (skipping culturing) and B) the same two qPCR for 23SrDNA and gyrA (including Sanger sequencing) with whole-genome sequencing (WGS) and phenotypic characterization of clarithromycin and levofloxacin resistance using 76 cultured isolates. The sensitivity of both qPCRs was 100% compared to that of the commercial IVD-marked hybridization probe assay for the detection of H. pylori in gastric biopsies (without resistance testing). The specificity of the qPCR gyrA followed by Sanger sequencing was 100%, indicating that the best sequence identity was always H. pylori. The results show good agreement between molecular tests, especially between qPCR (inclusive Sanger sequencing) and WGS. Discrepancies (concerning mutated or wild type of positive H. pylori gastric biopsies) were observed between Sanger sequencing of the gyrA gene and the corresponding commercial hybridization probe assay, mostly because the high sequence diversity of the gyrA gene even at positions adjacent to the relevant codons of 87 and 91 interfered with obtaining correct results from the hybridization probe assay. Interestingly, we found several mixed sequences, indicating mixed populations in the gastric biopsies (direct detection without culturing). There was a high percentage of both levofloxacin and clarithromycin resistance in gastric biopsies (both between 22% and 29%, direct detection in gastric biopsies). Therefore, we recommend analyzing both targets in parallel. We confirmed that phenotypic resistance is highly correlated with the associated mutations. We concluded that the two qPCR followed by Sanger sequencing of the gyrA gene is a fast, cost-effective and comprehensive method for resistance testing of H. pylori directly in gastric biopsies.
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Affiliation(s)
- Konrad Egli
- Labormedizinisches zentrum Dr Risch, Buchs, Switzerland
| | - Karoline Wagner
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland.,Laboratory Medicine, University Hospital of Basel, Basel, Switzerland
| | - Peter M Keller
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland.,Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Lorenz Risch
- Labormedizinisches zentrum Dr Risch, Buchs, Switzerland.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Martin Risch
- Labormedizinisches zentrum Dr Risch, Buchs, Switzerland
| | - Thomas Bodmer
- Labormedizinisches zentrum Dr Risch, Buchs, Switzerland
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Lee GH, Lee KM, Shin SJ, Kang JK, Noh CK, Kim JH, Lim SG. Impact of previous metronidazole exposure on metronidazole-based second-line quadruple therapy for Helicobacter pylori infection. Korean J Intern Med 2020; 35:1094-1103. [PMID: 32921010 PMCID: PMC7487300 DOI: 10.3904/kjim.2020.174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/AIMS The negative effects on the eradication success of Helicobacter pylori infection after previous exposure to macrolides, including clarithromycin on clarithromycin-based first-line therapy have been demonstrated. However, whether this is true for metronidazole-based second-line quadruple therapy remains unclear. We investigated the relationship between past administration of metronidazole and the failure of metronidazole-based second-line quadruple therapy in patients with H. pylori infection. METHODS Patients over 20 years of age who were diagnosed with H. pylori infection between January 1998 and March 2016 were enrolled in this study. The relationship between the clinical parameters and the results of a C13-urea breath test after metronidazole-based second-line quadruple therapy was analyzed in patients for whom clarithromycin-based triple therapy failed to eradicate H. pylori. RESULTS The H. pylori eradication failure rate was significantly higher in patients with a history of metronidazole use than in patients without a history of metronidazole use (p = 0.011). Multivariable analysis showed that the odds ratio of previous metronidazole use for eradication failure was 3.468 (95% confidence interval, 1.391 to 8.649; p = 0.008). In the subgroup analysis of patients with a history of metronidazole use, the duration of metronidazole use and interval between its use and eradication therapy did not significantly affect H. pylori eradication failure. CONCLUSION Previous exposure to metronidazole was a significant risk factor for treatment failure of metronidazole-based second-line quadruple therapy; therefore, this should be considered when establishing a treatment strategy for patients with H. pylori infection.
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Affiliation(s)
- Gil Ho Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Kee Myung Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Sung Jae Shin
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Joon Koo Kang
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Choong-Kyun Noh
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Jin Hong Kim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Sun Gyo Lim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
- Correspondence to Sun Gyo Lim, M.D. Department of Gastroenterology, Ajou University School of Medicine, 164 World cup-ro,
Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-6939 Fax: +82-31-219-5999 E-mail:
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10
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Tariq H, Patel H, Kamal MU, Abbas N, Ameen M, Azam S, Kumar K, Ravi M, Vootla V, Shaikh D, Amanchi V, Hussain AN, Makker J. Reevaluation of the Efficacy of First Line Regimen for Helicobacter pylori. Clin Exp Gastroenterol 2020; 13:25-33. [PMID: 32158248 PMCID: PMC6985979 DOI: 10.2147/ceg.s239343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/07/2020] [Indexed: 12/16/2022] Open
Abstract
Background Helicobacter pylori is a common cause of gastritis, peptic ulcer disease, and non-ulcer dyspepsia, and is also associated with gastric adenocarcinoma and mucosa associated lymphoid tissue lymphoma. Despite being known about for more than 30 years, finding an effective therapeutic strategy against it remains a challenge. Aim There are no US studies evaluating the efficacy of a Levofloxacin based therapy for H. pylori infection. We here intend to study the efficacy of Levofloxacin based triple antibiotic regimen as compared to Clarithromycin based triple therapy and Bismuth based quadruple therapy in our patient population. Methods This is a retrospective single center observational study. Patients with Helicobacter pylori infection who underwent treatment for H. pylori with one of the three therapies, i.e. Clarithromycin triple, Bismuth Quadruple or Levofloxacin triple, were included in the study and the eradication rates were compared. The confirmation of the H. pylori was done 4 weeks after the completion of anti-microbial therapy. Results A total of 177 individuals underwent the H. pylori treatment in our retrospective review. Of these, 54% (n=97) of patients were treated with Clarithromycin based triple therapy (Group 1), 35% (n=63) were treated with Levofloxacin based regimen (Group 2), and the remaining 11% (n=17) were treated with Bismuth based quadruple therapy (Group 3). The eradication rates were significantly higher in patients treated with Clarithromycin based triple therapy as compared to Levofloxacin based triple therapy and Bismuth quadruple therapy (78.3% vs 49.2% vs 41.1% P=0.001). Conclusion In conclusion, our study shows significantly lower eradication rates with Levofloxacin triple therapy among a selected US population. Thus, it may not be a good first-line therapy among this US population and the Clarithromycin based regimen may still be used successfully.
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Affiliation(s)
- Hassan Tariq
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, Bronx, NY 10457, USA
| | - Harish Patel
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, Bronx, NY 10457, USA
| | | | - Naeem Abbas
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, Bronx, NY 10457, USA
| | - Muhammad Ameen
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, USA
| | - Sara Azam
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, USA
| | - Kishore Kumar
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, Bronx, NY 10457, USA
| | - Madhavi Ravi
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, Bronx, NY 10457, USA
| | - Vamshidhar Vootla
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, Bronx, NY 10457, USA
| | - Danial Shaikh
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, Bronx, NY 10457, USA
| | - Vamsi Amanchi
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, USA
| | - Ali N Hussain
- Baruch College, City University of New York (CUNY), New York, NY 10010, USA
| | - Jasbir Makker
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, Bronx, NY 10457, USA
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Saracino IM, Fiorini G, Zullo A, Pavoni M, Saccomanno L, Vaira D. Trends in Primary Antibiotic Resistance in H. pylori Strains Isolated in Italy between 2009 and 2019. Antibiotics (Basel) 2020; 9:antibiotics9010026. [PMID: 31941121 PMCID: PMC7168339 DOI: 10.3390/antibiotics9010026] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND AIMS the increasing prevalence of strains resistant to antimicrobial agents is a critical issue for the management of Helicobacter pylori infection. This study aimed to evaluate, in Italian naïve patients, H. pylori antibiotic resistance trends and their potential predictive factors during the last decade. METHODS consecutive Italian naïve H. pylori positive patients, referred from General Practitioners to our Unit from January 2009 to January 2019 to perform an upper gastrointestinal endoscopy (UGIE), were considered. Each patient underwent 13C-urea breath test (13C-UBT) and UGIE with multiple biopsies to perform rapid urease test (RUT), culture/susceptibility test (vs. clarithromycin, metronidazole, levofloxacin), and histopathological examination. H. pylori status was assessed through CRM (composite reference method: at least two tests positive or only culture positive). RESULTS between 2009 and 2014, 1763 patients were diagnosed as H. pylori positive, 907 were naïve with antibiogram available. Between 2015 and 2019, 1415 patients were diagnosed as H. pylori positive, antibiotic susceptibility test was available in 739 naïve patients. H. pylori primary antibiotic resistance rates in the first and second five-year period were, respectively, clarithromycin 30.2% (95% CI 27.2-33.3), 37.8% (95% CI 34.2-41.4); metronidazole 33.3% (95% CI 30.2-36.5), 33.6% (95% CI 30.2-37.1); levofloxacin 25.6% (95% CI 22.8-28.5), 33.8% (95% CI 37.4-47.4), double resistance clarithromycin-metronidazole 18.9% (95% CI 16.4-21.6), 20.7% (95% CI 17.8-23.8). The increase of the resistance rates to clarithromycin and levofloxacin in naïve patients was statistically significant (p < 0.05). Although eradication rates for sequential therapy in the 10 years considered were 93.4% (95% CI 92-94.6) and 87.5% (95% CI 85.7-89) at per-protocol (PP) and intention-to-treat (ITT) analysis, respectively, they showed a significant decrease in the second five-year period. CONCLUSIONS this data highlights an increase in primary H. pylori antibiotic resistance and strongly suggests the importance of drug susceptibility testing also in naïve patients.
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Affiliation(s)
- Ilaria Maria Saracino
- Department of Surgical and Medical Sciences, University of Bologna, 40126 Bologna, Italy; (I.M.S.); (G.F.); (M.P.); (L.S.)
| | - Giulia Fiorini
- Department of Surgical and Medical Sciences, University of Bologna, 40126 Bologna, Italy; (I.M.S.); (G.F.); (M.P.); (L.S.)
| | - Angelo Zullo
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, 00153 Rome, Italy;
| | - Matteo Pavoni
- Department of Surgical and Medical Sciences, University of Bologna, 40126 Bologna, Italy; (I.M.S.); (G.F.); (M.P.); (L.S.)
| | - Laura Saccomanno
- Department of Surgical and Medical Sciences, University of Bologna, 40126 Bologna, Italy; (I.M.S.); (G.F.); (M.P.); (L.S.)
| | - Dino Vaira
- Department of Surgical and Medical Sciences, University of Bologna, 40126 Bologna, Italy; (I.M.S.); (G.F.); (M.P.); (L.S.)
- Correspondence:
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12
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Kouitcheu Mabeku LB, Eyoum Bille B, Tepap Zemnou C, Tali Nguefack LD, Leundji H. Broad spectrum resistance in Helicobacter pylori isolated from gastric biopsies of patients with dyspepsia in Cameroon and efflux-mediated multiresistance detection in MDR isolates. BMC Infect Dis 2019; 19:880. [PMID: 31640588 PMCID: PMC6806547 DOI: 10.1186/s12879-019-4536-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/09/2019] [Indexed: 12/17/2022] Open
Abstract
Background Antibiotic resistance is a leading cause of treatment failure in Helicobacter pylori infection. In Africa, there are very little data concerning the susceptibility of Helicobacter pylori isolates to antibiotics. The purpose of this study was to evaluate the resistance prevalence of Helicobacter pylori strains circulating in Cameroon, and to assess overexpression of efflux pump as a possible multi-drug resistance mechanisms. Methods A total of 140 H. pylori isolates were recovered from gastric biopsies of dyspeptic patients in two reference hospitals in Cameroon and analyzed for their antimicrobial susceptibility to amoxicillin, co-amoxiclav, ampicillin, penicillin, imipenem, metronidazole, rifabutin, erythromycin, clarithromycin, azithromycin, levofloxacin, ciprofloxacin, norfloxacin, tetracycline, doxycycline and minocycline. Antibiotic sensitivity was tested by disk diffusion method. Phe-Arg-naphthylamide (PAßN) was used as efflux pump inhibitor. INT broth microdilution method in supplemented Brain Heart Infusion broth was used to determine the MIC of ampicillin, amoxicillin, metronidazole, erythromycin, clarithromycin and doxycycline in the absence and the presence of PAßN against 32 selected MDR isolates. Results Overall H. pylori resistance rate was 100% to ampicillin, penicillin and co-amoxiclav; 97.14% to amoxicillin, 97.85% to metronidazole, 47.85% to erythromycin, 13.57% to clarithromycin; 5, 2.86 and 0.71% to doxycycline, tetracycline and minocycline respectively. No resistance to azithromycin, rifabutin, imipenem, ciprofloxacin, norfloxacin and levofloxacin was detected among H. pylori isolates. Seventy percent (70%) of the tested isolates elicited a multiple drugs resistance pattern; 42.57% double, 15.71% triple and 5.71% quadruple drugs resistance. Metronidazole and amoxicillin were more concerned with double resistance pattern (86.76%). The spectrum of activity recorded with metronidazole, doxycycline, clarithromycin and erythromycin ranged from 0 to 100% in the absence to the presence of PAßN against the tested MDR isolates. An 8 to 128-fold increase in potency was also noticed with these antibiotics in the presence of PAßN. Conclusion With regard to the high resistance rate to both amoxicillin and metronidazole, these drugs should be avoided as components of triple therapy in our milieu. In contrast, ciprofloxacin, norfloxacin, levofloxacin and tetracyclines could be used to achieve a better eradication rate and to reduce the risk of selection of H. pylori resistant strains.
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Affiliation(s)
- Laure Brigitte Kouitcheu Mabeku
- Microbiology and Pharmacology Laboratory, Department of Biochemistry, Faculty of Science, University of Dschang, P. O. Box, 67, Dschang, Cameroon.
| | - Bertrand Eyoum Bille
- Microbiology and Pharmacology Laboratory, Department of Biochemistry, Faculty of Science, University of Dschang, P. O. Box, 67, Dschang, Cameroon
| | - Cromwell Tepap Zemnou
- Microbiology and Pharmacology Laboratory, Department of Biochemistry, Faculty of Science, University of Dschang, P. O. Box, 67, Dschang, Cameroon
| | - Lionel Danny Tali Nguefack
- Microbiology and Pharmacology Laboratory, Department of Biochemistry, Faculty of Science, University of Dschang, P. O. Box, 67, Dschang, Cameroon
| | - Hubert Leundji
- Gastroenterology Department, Laquintinie Hospital of Douala, P. O. Box, 4035, Douala, Cameroon
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13
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Pohl D, Keller PM, Bordier V, Wagner K. Review of current diagnostic methods and advances in Helicobacter pylori diagnostics in the era of next generation sequencing. World J Gastroenterol 2019; 25:4629-4660. [PMID: 31528091 PMCID: PMC6718044 DOI: 10.3748/wjg.v25.i32.4629] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/25/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection is highly prevalent in the human population and may lead to severe gastrointestinal pathology including gastric and duodenal ulcers, mucosa associated tissue lymphoma and gastric adenocarcinoma. In recent years, an alarming increase in antimicrobial resistance and subsequently failing empiric H. pylori eradication therapies have been noted worldwide, also in many European countries. Therefore, rapid and accurate determination of H. pylori’s antibiotic susceptibility prior to the administration of eradication regimens becomes ever more important. Traditionally, detection of H. pylori and its antimicrobial resistance is done by culture and phenotypic drug susceptibility testing that are cumbersome with a long turn-around-time. Recent advances in diagnostics provide new tools, like real-time polymerase chain reaction (PCR) and line probe assays, to diagnose H. pylori infection and antimicrobial resistance to certain antibiotics, directly from clinical specimens. Moreover, high-throughput whole genome sequencing technologies allow the rapid analysis of the pathogen’s genome, thereby allowing identification of resistance mutations and associated antibiotic resistance. In the first part of this review, we will give an overview on currently available diagnostic methods for detection of H. pylori and its drug resistance and their implementation in H. pylori management. The second part of the review focusses on the use of next generation sequencing technology in H. pylori research. To this end, we conducted a literature search for original research articles in English using the terms “Helicobacter”, “transcriptomic”, “transcriptome”, “next generation sequencing” and “whole genome sequencing”. This review is aimed to bridge the gap between current diagnostic practice (histology, rapid urease test, H. pylori culture, PCR and line probe assays) and new sequencing technologies and their potential implementation in diagnostic laboratory settings in order to complement the currently recommended H. pylori management guidelines and subsequently improve public health.
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Affiliation(s)
- Daniel Pohl
- Division of Gastroenterology, University Hospital of Zurich, Zurich 8006, Switzerland
| | - Peter M Keller
- Institute for Infectious Diseases, University of Bern, Bern 3010, Switzerland
| | - Valentine Bordier
- Division of Gastroenterology, University Hospital of Zurich, Zurich 8006, Switzerland
| | - Karoline Wagner
- Institute of Medical Microbiology, University of Zurich, Zurich 8006, Switzerland
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14
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Rizvanov AA, Haertlé T, Bogomolnaya L, Talebi Bezmin Abadi A. Helicobacter pylori and Its Antibiotic Heteroresistance: A Neglected Issue in Published Guidelines. Front Microbiol 2019; 10:1796. [PMID: 31456763 PMCID: PMC6700363 DOI: 10.3389/fmicb.2019.01796] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/22/2019] [Indexed: 12/19/2022] Open
Abstract
"Heteroresistance" is a widely applied term that characterizes most of the multidrug-resistant microorganisms. In microbiological practice, the word "heteroresistance" indicates diverse responses to specific antibiotics by bacterial subpopulations in the same patient. These resistant subpopulations of heteroresistant strains do not respond to antibiotic therapy in vitro or in vivo. Presently, there is no standard protocol available for the treatment of infections caused by heteroresistant Helicobacter pylori in clinical settings, at least according to recent guidelines. Thus, there is a definite need to open a new discussion on how to recognize, how to screen, and how to eliminate those problematic strains in clinical and environmental samples. Since there is great interest in developing new strategies to improve the eradication rate of anti-H. pylori treatments, the presence of heteroresistant strains/clones among clinical isolates of the bacteria should be taken into account. Indeed, increased knowledge of gastroenterologists about the existence of heteroresistance phenomena is highly required. Moreover, the accurate breakpoints should be examined/determined in order to have a solid statement of heteroresistance among the H. pylori isolates. The primary definition of heteroresistance was about coexistence of both resistant and susceptible isolates at the similar gastric microniche at once, while we think that it can be happened subsequently as well. The new guidelines should include a personalized aspect in the standard protocol to select a precise, effective antibiotic therapy for infected patients and also address the problems of regional antibiotic susceptibility profiles.
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Affiliation(s)
- Albert A. Rizvanov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Thomas Haertlé
- Biopolymers Interactions Assemblies, Institut National de la Recherche Agronomique, Nantes, France
- Department of Animal Nutrition and Feed Management, Poznan University of Life Sciences, Poznań, Poland
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Lydia Bogomolnaya
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
- Department of Microbial Pathogenesis and Immunology, Texas A&M University Health Science Center, Bryan, TX, United States
| | - Amin Talebi Bezmin Abadi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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15
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Morilla AM, Álvarez-Argüelles ME, Duque JM, Armesto E, Villar H, Melón S. Primary antimicrobial resistance rates and prevalence of Helicobacter pylori infection in the north of Spain. A 13-year retrospective study. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:476-485. [PMID: 31324461 DOI: 10.1016/j.gastrohep.2019.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/18/2019] [Accepted: 05/06/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Helicobacter pylori resistance to antimicrobial agents is on the rise and it is thus imperative to be aware of local resistance rates. The main objective of the present study was to describe the evolution of primary antimicrobial resistance in H. pylori, analysing its antibiotic susceptibility over a 13-year period in a region of northern Spain, as well as host-related factors. PATIENTS AND METHODS Between 2004 and 2016 a total of 3426 patients who met the H. pylori eradication criteria underwent gastroscopy. The gastric biopsies were processed and those testing positive for H. pylori were identified and tested for clarithromycin, metronidazole and levofloxacin susceptibility using E-test. RESULTS H. pylori was isolated in 1604 (47%) patients, ranging from 63% (133/212) in 2004 to 39% (137/347) in 2016. Primary resistances to clarithromycin, metronidazole and levofloxacin were on average 19% (278/1116), 40% (572/865) and 17% (137/669), respectively. Clarithromycin resistance was 24% (167/686) in females and 15% (11/753) in males (p=0.0002); metronidazole resistance was 29% (72/246) in patients over 70 years compared to 42% (499/1190) in younger patients (p=0.0396); levofloxacin resistance increased with age, being 13% (57/439) in patients ≤55 years, 19% (46/236) for those between 56 and 70, and 26% (34/130) in patients >70 years (p=0.0087). DISCUSSION A decline in the prevalence of H. pylori infection was observed over the years, along with relatively high rates of primary resistance to clarithromycin, metronidazole and levofloxacin. Variations in resistance rates were found with sex and age.
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Affiliation(s)
- Ana Morilla Morilla
- Department of Microbiology, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain.
| | - Marta E Álvarez-Argüelles
- Department of Microbiology, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain
| | - Jose María Duque
- Department of Gastroenterology, Hospital Universitario San Agustín, Camino de Heros, 6, 33401 Avilés, Asturias, Spain
| | - Edisa Armesto
- Department of Gastroenterology, Hospital Universitario San Agustín, Camino de Heros, 6, 33401 Avilés, Asturias, Spain
| | - Henar Villar
- Department of Microbiology, Hospital Universitario San Agustín, Camino de Heros, 6, 33401 Avilés, Asturias, Spain
| | - Santiago Melón
- Department of Microbiology, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain
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16
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Antibiotic dispensation rates among participants in community-driven health research projects in Arctic Canada. BMC Public Health 2019; 19:949. [PMID: 31307422 PMCID: PMC6631451 DOI: 10.1186/s12889-019-7193-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 06/18/2019] [Indexed: 02/08/2023] Open
Abstract
Background Community-driven projects that aim to address public concerns about health risks from H. pylori infection in Indigenous Arctic communities (estimated H. pylori prevalence = 64%) show frequent failure of treatment to eliminate the bacterium. Among project participants, treatment effectiveness is reduced by antibiotic resistance of infecting H. pylori strains, which in turn, is associated with frequent exposure to antibiotics used to treat other infections. This analysis compares antibiotic dispensation rates in Canadian Arctic communities to rates in urban and rural populations in Alberta, a southern Canadian province. Methods Project staff collected antibiotic exposure histories for 297 participants enrolled during 2007–2012 in Aklavik, Tuktoyaktuk, and Fort McPherson in the Northwest Territories, and Old Crow, Yukon. Medical chart reviews collected data on systemic antibiotic dispensations for the 5-year period before enrolment for each participant. Antibiotic dispensation data for urban Edmonton, Alberta (average population ~ 860,000) and rural northern Alberta (average population ~ 450,000) during 2010–2013 were obtained from the Alberta Government Interactive Health Data Application. Results Antibiotic dispensation rates, estimated as dispensations/person-years (95% confidence interval) were: in Arctic communities, 0.89 (0.84, 0.94); in Edmonton, 0.55 (0.55, 0.56); in rural northern Alberta, 0.63 (0.62, 0.63). Antibiotic dispensation rates were higher in women and older age groups in all regions. In all regions, the highest dispensation rates occurred for β-lactam and macrolide antibiotic classes. Conclusions These results show more frequent antibiotic dispensation in Arctic communities relative to an urban and rural southern Canadian population.
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17
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Gatta L, Scarpignato C, Fiorini G, Belsey J, Saracino IM, Ricci C, Vaira D. Impact of primary antibiotic resistance on the effectiveness of sequential therapy for Helicobacter pylori infection: lessons from a 5-year study on a large number of strains. Aliment Pharmacol Ther 2018. [PMID: 29536561 DOI: 10.1111/apt.14597] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The increasing prevalence of strains resistant to antimicrobial agents is a critical issue in the management of Helicobacter pylori (H. pylori) infection. AIMS (1) To evaluate the prevalence of primary resistance to clarithromycin, metronidazole and levofloxacin (2) to assess the effectiveness of sequential therapy on resistant strains (3) to identify the minimum number of subjects to enrol for evaluating the effectiveness of an eradication regimen in patients harbouring resistant strains. METHODS Consecutive 1682 treatment naïve H. pylori-positive patients referred for upper GI endoscopy between 2010 and 2015 were studied and resistances assessed by E-test. Sequential therapy was offered, effectiveness evaluated and analysed. RESULTS H. pylori-primary resistance to antimicrobials tested was high, and increased between 2010 and 2015. Eradication rates were (estimates and 95% CIs): 97.3% (95.6-98.4) in strains susceptible to clarithromycin and metronidazole; 96.1% (91.7-98.2) in strains resistant to metronidazole but susceptible to clarithromycin; 93.4% (88.2-96.4) in strains resistant to clarithromycin but susceptible to metronidazole; 83.1% (77.7-87.3) in strains resistant to clarithromycin and metronidazole. For any treatment with a 75%-85% eradication rate, some 98-144 patients with resistant strains need to be studied to get reliable information on effectiveness in these patients. CONCLUSIONS H. pylori-primary resistance is increasing and represents the most critical factor affecting effectiveness. Sequential therapy eradicated 83% of strains resistant to clarithromycin and metronidazole. Reliable estimates of the effectiveness of a given regimen in patients harbouring resistant strains can be obtained only by assessing a large number of strains.
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Affiliation(s)
- L Gatta
- Gastroenterogy Unit, Versilia Hospital, Azienda USL Toscana Nord Ovest, Lido di Camaiore, Italy.,Clinical Pharmacology and Digestive Pathophysiology Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - C Scarpignato
- Clinical Pharmacology and Digestive Pathophysiology Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - G Fiorini
- Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - I M Saracino
- Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - C Ricci
- Gastroenterology Unit, 'Spedali Civili' Hospital, University of Brescia, Brescia, Italy
| | - D Vaira
- Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy
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18
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Branquinho D, Almeida NMPD, Gregório C, Casela A, Donato MM, Tomé L. Twelve-day quintuple regime containing four antibiotics as a rescue therapy for Helicobacter pylori eradication in the central region of Portugal. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 109:430-434. [PMID: 28530108 DOI: 10.17235/reed.2017.4759/2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Helicobacter pylori eradication rates with standard triple therapy in many countries are clinically unacceptable. Fluoroquinolone resistance is increasing and jeopardizing second-line regimens. There is a growing need for an effective strategy in patients who failed previous therapies. METHODS This is a single-center, non-randomized clinical study conducted in the central region of Portugal. Sixty-four patients were included with a positive 13C-urea breath test (UBT) or histology for H. pylori, and at least one failed eradication attempt. The patient cohort included 71.7% of females with a median of age of 52 (range 23-87). They were treated with a twelve-day regimen consisting of a proton-pump inhibitor (PPI) bid, amoxicillin at 1,000 mg 12/12 h and levofloxacin at 500 mg bid during the first seven days, followed by PPI bid, clarithromycin at 500 mg 12/12h and either tinidazole or metronidazole at 500 mg bid/tid for five days. Eradication was assessed by UBT. The local Ethics Committee approved this study. RESULTS Eradication therapy was prescribed due to dyspepsia (66.7%), peptic ulcer (10%) and thrombocytopenia (8.3%). The median number of failed therapies was one (range 1-4). The eradication rate was 64.6% according to an intention-to-treat analysis (95% CI: 53-77%), and 70% by the per-protocol analysis (95% CI: 58-82%). Age, smoking, indication for eradication, previous therapies and the use of a second-generation or full-dose PPI did not affect success rates. CONCLUSIONS Even though treatment with four antibiotics was used, this "reinforced" therapy achieved suboptimal results. This fact highlights the lack of effective H. pylori antimicrobials and suggests that second-line treatment in our region should be prescribed according to susceptibility testing.
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Affiliation(s)
- Diogo Branquinho
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
| | | | - Carlos Gregório
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra
| | - Adriano Casela
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra
| | | | - Luís Tomé
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra
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Macías-García F, Llovo-Taboada J, Díaz-López M, Bastón-Rey I, Domínguez-Muñoz JE. High primary antibiotic resistance of Helicobacter Pylori strains isolated from dyspeptic patients: A prevalence cross-sectional study in Spain. Helicobacter 2017; 22. [PMID: 28913872 DOI: 10.1111/hel.12440] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The rate of H. pylori resistance to different antibiotics is increasing and determines the selection of eradication therapy. The aim of this study was to determine the resistance patterns of H. pylori strains in our area. METHODS Biopsies from gastric corpus for microbiological culture and antibiotic resistance were obtained in patients undergoing upper gastrointestinal endoscopy for dyspepsia. Selective Agar Pylori for isolation of the bacteria and Agar Mueller-Hinton supplemented with blood to test the sensitivity to antibiotics were used. Presence of H. pylori was confirmed using direct observation with phase-contrast microscopy and/or smears stained with acridine orange. In vitro bacterial susceptibility to amoxicillin, clarithromycin, rifampicin, tetracycline, metronidazole, and levofloxacin was tested using diffusion MIC test strips. Minimum inhibitory concentration values were determined based on the 6th version of the EUCAST (European Committee on Antimicrobial Susceptibility Testing) Clinical Breakpoint (2016). RESULTS Two hundred and seventeen patients were included (58.1% female, median age 64 years, range 25-92). H. pylori was identified in 108 patients (49.8%); culture and antibiogram were completed in 77 of them (71.3% of H. pylori-positive patients). The resistance rates were as follows: levofloxacin 38.7%, rifampicin 33.3%, metronidazole 27% and clarithromycin 22.4%. No case of amoxicillin or tetracycline resistance was identified. Dual clarithromycin-metronidazole resistance was observed in 10% of strains, whereas multiple drug-resistant was observed in 14.2%. CONCLUSIONS Resistance rate of H. pylori to antibiotics is high in the northwest of Spain. The high resistance to levofloxacin and clarithromycin advises against their wide empirical use of these antibiotics in eradication regimens.
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Affiliation(s)
- Fernando Macías-García
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Llovo-Taboada
- Department of Microbiology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mario Díaz-López
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Iria Bastón-Rey
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Enrique Domínguez-Muñoz
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
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20
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Navarro-Jarabo JM, Fernández-Sánchez F, Fernández-Moreno N, Hervas-Molina AJ, Casado-Caballero F, Puente-Gutierrez JJ, Pallares-Manrique H, Rodríguez-Ramos C, Fernández-Gutierrez C, Pérez-Aisa A, Rivas-Ruiz F, Montiel Quezel-Guerraz N. Prevalence of Primary Resistance of Helicobacter pylori to Clarithromycin and Levofloxacin in Southern Spain. Digestion 2017; 92:78-82. [PMID: 26227669 DOI: 10.1159/000435949] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 06/14/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The eradication of Helicobacter pylori (HP) using clarithromycin (CLA)-based triple therapy depends on the resistance of HP to antibiotics. The Maastricht III conference recommends the implementation of locoregional surveillance programmes for primary resistance of HP to CLA. In Andalusia, there are no previous data in this respect. The aim of this study was to determine the prevalence of the primary resistance of HP to CLA and levofloxacin (LF) in southern Spain. METHODS Multicentre cross sectional study was carried out in 6 hospitals in Andalusia. Patients of both sexes numbering 401 were included (male 48%), aged 18-80 years and naïve to HP eradication. Resistance of HP to CLA (CLAr) and LF (LFr) was assessed by determining mutations by PCR: mutations of the 23S rRNA gene define CLAr and mutations of the gene gyrA define LFr. Four hundred one gastric samples were collected. CLAr was detected in 72 patients (17.9%) and LFr was detected in 56 patients (13.9%). Heteroresistance was detected for both antibiotics: CLA 37/72 (51.3%) and LF 28/56 (50%). Variability for CLAr was detected among the centres, ranging from 11.5% to 24.7% without statistical significance (p = 0.12). Female sex was related to CLAr. CONCLUSIONS In Andalusia, there is a high rate of primary CLAr and LFr. CLA-based triple therapy should be avoided as the primary eradication regimen in this region. There is a wide variability in the rate of CLAr among centres.
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Talebi Bezmin Abadi A. Helicobacter pylori treatment: New perspectives using current experience. J Glob Antimicrob Resist 2017; 8:123-130. [DOI: 10.1016/j.jgar.2016.11.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/10/2016] [Accepted: 11/20/2016] [Indexed: 02/08/2023] Open
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22
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Optimal First-Line Treatment for Helicobacter pylori Infection: Recent Strategies. Gastroenterol Res Pract 2016; 2016:9086581. [PMID: 28070184 PMCID: PMC5187483 DOI: 10.1155/2016/9086581] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/15/2016] [Accepted: 11/03/2016] [Indexed: 01/06/2023] Open
Abstract
A new treatment strategy is needed, as the efficacy of triple therapy containing clarithromycin—the current standard treatment for Helicobacter pylori infection—is declining. Increasing antibiotic resistance of H. pylori is the most significant factor contributing to eradication failure. Thus, selecting the most appropriate regimen depending on resistance is optimal, but identifying resistance to specific antibiotics is clinically challenging. In a region suspected to have high clarithromycin resistance, bismuth quadruple therapy and so-called nonbismuth quadruple therapies (sequential, concomitant, and sequential-concomitant hybrid) are some first-line regimen options. However, more research is needed regarding appropriate second-line treatments after first-line treatment failure. Tailored therapy, which is based on antibiotic sensitivity testing, would be optimal but has several limitations for clinical use, and an alternative technique is required. A novel potassium-competitive acid blocker-based eradication regimen could be a valuable eradication option in the near future.
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Sanches BS, Martins GM, Lima K, Cota B, Moretzsohn LD, Ribeiro LT, Breyer HP, Maguilnik I, Maia AB, Rezende-Filho J, Meira AC, Pinto H, Alves E, Mascarenhas R, Passos R, de Souza JD, Trindade OR, Coelho LG. Detection of Helicobacter pylori resistance to clarithromycin and fluoroquinolones in Brazil: A national survey. World J Gastroenterol 2016; 22:7587-7594. [PMID: 27672279 PMCID: PMC5011672 DOI: 10.3748/wjg.v22.i33.7587] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 06/28/2016] [Accepted: 07/06/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate bacterial resistance to clarithromycin and fluoroquinolones in Brazil using molecular methods.
METHODS The primary antibiotic resistance rates of Helicobacter pylori (H. pylori) were determined from November 2012 to March 2015 in the Southern, South-Eastern, Northern, North-Eastern, and Central-Western regions of Brazil. Four hundred ninety H. pylori patients [66% female, mean age 43 years (range: 18-79)] who had never been previously treated for this infection were enrolled. All patients underwent gastroscopy with antrum and corpus biopsies and molecular testing using GenoType HelicoDR (Hain Life Science, Germany). This test was performed to detect the presence of H. pylori and to identify point mutations in the genes responsible for clarithromycin and fluoroquinolone resistance. The molecular procedure was divided into three steps: DNA extraction from the biopsies, multiplex amplification, and reverse hybridization.
RESULTS Clarithromycin resistance was found in 83 (16.9%) patients, and fluoroquinolone resistance was found in 66 (13.5%) patients. There was no statistical difference in resistance to either clarithromycin or fluoroquinolones (P = 0.55 and P = 0.06, respectively) among the different regions of Brazil. Dual resistance to clarithromycin and fluoroquinolones was found in 4.3% (21/490) of patients. The A2147G mutation was present in 90.4% (75/83), A2146G in 16.9% (14/83) and A2146C in 3.6% (3/83) of clarithromycin-resistant patients. In 10.8% (9/83) of clarithromycin-resistant samples, more than 01 mutation in the 23S rRNA gene was noticed. In fluoroquinolone-resistant samples, 37.9% (25/66) showed mutations not specified by the GenoType HelicoDR test. D91N mutation was observed in 34.8% (23/66), D91G in 18.1% (12/66), N87K in 16.6% (11/66) and D91Y in 13.6% (9/66) of cases. Among fluoroquinolone-resistant samples, 37.9% (25/66) showed mutations not specified by the GenoType HelicoDR test.
CONCLUSION The H. pylori clarithromycin resistance rate in Brazil is at the borderline (15%-20%) for applying the standard triple therapy. The fluoroquinolone resistance rate (13.5%) is equally concerning.
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Lim SG, Park RW, Shin SJ, Yoon D, Kang JK, Hwang JC, Kim SS, Kim JH, Lee KM. The relationship between the failure to eradicate Helicobacter pylori and previous antibiotics use. Dig Liver Dis 2016; 48:385-90. [PMID: 26856963 DOI: 10.1016/j.dld.2015.12.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/30/2015] [Accepted: 12/03/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The previous use of antibiotics is known to correlate positively with antibiotic resistance; whether this is also the case in the eradication of Helicobacter pylori infection is unclear. AIM To investigate the relationship between the previous use of antibiotics and the failure of eradication therapy in H. pylori infection. METHODS The relationship between the clinical parameters and the failure of H. pylori eradication was analyzed in patients administered standard triple therapy and then assessed for the eradication of H. pylori based on a C13-urea breath test. RESULTS In a multivariate analysis, failure rates increased significantly in patients with a history of clarithromycin (odds ratio [OR], 4.445) or other macrolides (OR, 2.407) use, who were female (OR, 1.339), or who were older than 60 years of age (OR, 1.326). The eradication failure rate in patients with a history of macrolides use for >2 weeks was significantly higher than if the duration of use was <2 weeks (44.8% vs. 29.3%, p=0.047). CONCLUSIONS A patient's history of macrolides is a useful predictor of the likelihood of standard triple therapy failure in H. pylori eradication. The alternatives such as a bismuth-based quadruple or a levofloxacin-containing therapy should be considered in patients treated with macrolides for >2 weeks.
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Affiliation(s)
- Sun Gyo Lim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Sung Jae Shin
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Dukyong Yoon
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Joon Koo Kang
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Jae Chul Hwang
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Soon Sun Kim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Jin Hong Kim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Kee Myung Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
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25
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Hu B, Zhao F, Wang S, Olszewski MA, Bian H, Wu Y, Kong M, Xu L, Miao Y, Fang Y, Yang C, Zhao H, Zhang Y. A high-throughput multiplex genetic detection system for Helicobacter pylori identification, virulence and resistance analysis. Future Microbiol 2016; 11:1261-1278. [PMID: 27023051 DOI: 10.2217/fmb-2016-0023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM We established a high-throughput multiplex genetic detection system (HMGS) for identification of Helicobacter pylori with concomitant analysis of virulence and drug resistance. MATERIALS & METHODS Confirmed 132 H. pylori cultures from gastric biopsies were screened by 20-gene site-HMGS, sequencing and E-test. RESULTS HMGS was highly sensitive and specific for H. pylori identification. Concordance rate between HMGS and sequencing averaged 94.5% (virulence genes) and 97.3% (resistance genes). Observed resistance rates to four mainstream antibiotics were high, except for amoxicillin. Significant association between virulence genotype and risks for specific gastrointestinal diseases was found for five genes. Metronidazole resistance in peptic ulcer patients was significantly higher. CONCLUSION HMGS is an effective method for H. pylori identification and analysis of virulence and drug resistance.
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Affiliation(s)
- Binjie Hu
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, No. 221 Yanan West Road, Shanghai, 200040, China
| | - Fuju Zhao
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, No. 221 Yanan West Road, Shanghai, 200040, China
| | - Shiwen Wang
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, No. 221 Yanan West Road, Shanghai, 200040, China
| | - Michal A Olszewski
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System & Research Service, VA Ann Arbor Health Systems, Ann Arbor, MI, USA
| | - Haipeng Bian
- Department of Gastroenterology, Tongji Hospital Affiliated to Shanghai Tongji University, Shanghai, China
| | - Yong Wu
- Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Mimi Kong
- Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Lingli Xu
- Shanghai ABSciex Analytical Instrument Trading Co., Ltd., Shanghai, China
| | - Yingxin Miao
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, No. 221 Yanan West Road, Shanghai, 200040, China
| | - Yi Fang
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, No. 221 Yanan West Road, Shanghai, 200040, China
| | - Changqing Yang
- Department of Gastroenterology, Tongji Hospital Affiliated to Shanghai Tongji University, Shanghai, China
| | - Hu Zhao
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, No. 221 Yanan West Road, Shanghai, 200040, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging & Medicine, Fudan University, Shanghai, China
| | - Yanmei Zhang
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, No. 221 Yanan West Road, Shanghai, 200040, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging & Medicine, Fudan University, Shanghai, China
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Kale-Pradhan PB, Mihaescu A, Wilhelm SM. Fluoroquinolone Sequential Therapy for Helicobacter pylori: A Meta-analysis. Pharmacotherapy 2015; 35:719-30. [PMID: 26173786 DOI: 10.1002/phar.1614] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVE As resistance of Helicobacter pylori to standard first-line therapy is increasing globally, alternative treatment regimens, such as a fluoroquinolone-based sequential regimen, have been explored. The objective of this meta-analysis was to compare the efficacy of fluoroquinolone-based sequential therapy with standard first-line treatment for H. pylori infection. DESIGN Meta-analysis of six randomized controlled trials. PATIENTS A total of 738 H. pylori-infected, treatment-naive adults who received fluoroquinolone-based sequential therapy (5-7 days of a proton pump inhibitor [PPI] and amoxicillin therapy followed by 5-7 days of a PPI, a fluoroquinolone, and metronidazole or tinidazole or furazolidone therapy) and 733 H. pylori-infected, treatment-naive adults who received guideline-recommended, first-line therapy with standard triple therapy (7-14 days of a PPI plus amoxicillin and clarithromycin) or standard sequential therapy (5 days of a PPI plus amoxicillin, followed by an additional 5 days of triple therapy consisting of a PPI, clarithromycin, and metronidazole or tinidazole). MEASUREMENTS AND MAIN RESULTS A systematic literature search of the MEDLINE, PubMed, and Cochrane Central Register of Controlled Trials databases (from inception through January 2015) was conducted to identify randomized controlled trials that compared fluoroquinolone-based sequential therapy with guideline-recommended, first-line treatment regimens in H. pylori-infected, treatment-naive adults. All selected trials confirmed H. pylori infection prior to treatment as well as post-treatment eradication. A meta-analysis was performed by using Review Manager 5.2. Treatment effect was determined with a random-effects model by using the Mantel-Haenszel method and was reported as a risk ratio (RR) with 95% confidence interval (CI). In the six randomized controlled trials that met the inclusion criteria, 648 (87.8%) of 738 patients receiving fluoroquinolone-based sequential therapy and 521 (71.1%) of 733 patients receiving standard regimens achieved eradication (RR 1.21, 95% CI 1.09-1.35). The frequencies of adverse effects that were reported in three of the trials were comparable for all treatments (RR 0.99, 95% CI 0.76-1.29). In addition, no statistically significant difference was noted in the number of patients who experienced adverse effects that prompted discontinuation of therapy (RR 1.03, 95% CI 0.34-3.09). The H. pylori eradication rate appeared similar among the six trials with respect to duration of therapy and daily dose of the fluoroquinolone. CONCLUSION Fluoroquinolone-based sequential therapy is a reasonable treatment alternative to first-line eradication therapy for treatment of H. pylori.
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Affiliation(s)
- Pramodini B Kale-Pradhan
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, Michigan.,St. John Hospital and Medical Center, Detroit, Michigan
| | - Anela Mihaescu
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, Michigan
| | - Sheila M Wilhelm
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, Michigan.,Harper University Hospital, Detroit, Michigan
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27
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Paoluzi OA, Del Vecchio Blanco G, Visconti E, Coppola M, Fontana C, Favaro M, Pallone F. Low efficacy of levofloxacin-doxycycline-based third-line triple therapy for Helicobacter pylori eradication in Italy. World J Gastroenterol 2015; 21:6698-6705. [PMID: 26074708 PMCID: PMC4458780 DOI: 10.3748/wjg.v21.i21.6698] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/23/2015] [Accepted: 02/13/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate a levofloxacin-doxycycline-based triple therapy with or without a susceptibility culture test in non-responders to Helicobacter pylori (H. pylori) eradication.
METHODS: A total of 142 (99 women, 43 men; mean 53.0 ± 12.7 years) non-responders to more than two H. pylori eradication therapies underwent susceptibility culture tests or were treated with a seven-day triple therapy consisting of esomeprazole, 20 mg b.i.d., levofloxacin, 500 mg b.i.d., and doxycycline, 100 mg b.i.d., randomly associated with (n = 71) or without (n = 71) Lactobacillus casei DG. H. pylori status was checked in all patients at enrollment and at least 8 wk after the end of therapy. Compliance and tolerability of regimens were also assessed.
RESULTS: H. pylori eradication was achieved in < 50% of patients [per prototol (PP) = 49%; intention to treat (ITT) = 46%]. Eradication rate was higher in patients administered probiotics than in those without (PP = 55% vs 43%; ITT = 54% vs 40%). Estimated primary resistance to levofloxacin was 18% and multiple resistance was 31%. Therapy was well tolerated, and side effects were generally mild, with only one patient experiencing severe effects.
CONCLUSION: Third-line levofloxacin-doxycycline triple therapy had a low H. pylori eradication efficacy, though the success and tolerability of this treatment may be enhanced with probiotics.
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Primary Antimicrobial Susceptibility Changes in Children with Helicobacter pylori Infection over 13 Years in Northern Italy. Gastroenterol Res Pract 2015; 2015:717349. [PMID: 26064096 PMCID: PMC4438156 DOI: 10.1155/2015/717349] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 03/19/2015] [Indexed: 02/08/2023] Open
Abstract
The eradication therapy of Helicobacter pylori (H. pylori) infection is still a challenge for gastroenterologists. One of the main causes of failure in H. pylori eradication is the antibiotic resistance mainly to clarithromycin. Culture from biopsies is maybe the most used method among the antimicrobial susceptibility techniques. In this study, we compared the antimicrobial susceptibility changes in children with H. pylori infection over 13 years and we confirmed that clarithromycin resistance has been increased (16% versus 26%) though with no statistically signficant value. Therefore, clarithromycin should not be used in empiric treatment of H. pylori eradication therapy in children, but its use should be limited only to children with known antimicrobial susceptibility. On the other hand, metronidazole resistance has decreased over this time period in statistically significant manner (56% versus 33%, p = 0.014). Furthermore, ampicillin resistance has been confirmed to be very rare (3% versus 0%) in children with H. pylori infection. In conclusion, in H. pylori infection, if we do not know the antibiotic susceptibility of patients, we should recommend an eradication therapy based on the local distribution of antibiotic resistance rates trying to limit the therapeutic failures.
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29
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Zhang YX, Zhou LY, Song ZQ, Zhang JZ, He LH, Ding Y. Primary antibiotic resistance of Helicobacter pylori strains isolated from patients with dyspeptic symptoms in Beijing: A prospective serial study. World J Gastroenterol 2015; 21:2786-2792. [PMID: 25759550 PMCID: PMC4351232 DOI: 10.3748/wjg.v21.i9.2786] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/24/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the resistance patterns of Helicobacter pylori (H. pylori) strains isolated from patients in Beijing and monitor the change of antibiotic resistance over time.
METHODS: In this prospective, serial and cross-sectional study, H. pylori cultures were successfully obtained from 371 and 950 patients (never receiving eradication) during 2009-2010 and 2013-2014, respectively. Resistance to amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and rifampicin was determined by Epsilometer test.
RESULTS: The resistance rates of isolates obtained during 2009-2010 were 66.8%, 39.9%, 34.5%, 15.4%, 6.7%, and 4.9% to metronidazole, clarithromycin, levofloxacin, rifampicin, amoxicillin and tetracycline, respectively; and the corresponding rates for isolates during 2013-2014 were 63.4%, 52.6%, 54.8%, 18.2%, 4.4% and 7.3%, respectively. The resistance rates to clarithromycin and levofloxacin were significantly increased after four years. In 2009-2010, 14.6% of H. pylori isolates were susceptible to all tested antibiotics, with mono (33.7%), double (28.3%), triple (16.7%), quadruple (6.2%), quintuple (0.3%) and sextuple resistance (0.3%) also being detected. In 2013-2014, 9.4% were susceptible to all tested antibiotics, and mono (27.6%), double (28.4%), triple (24.9%), quadruple (7.3%), quintuple (2.3%) and sextuple resistance (0.1%) was also observed. More multiple resistant H. pylori isolates were found during 2013-2014. Gender (to levofloxacin and metronidazole), age (to levofloxacin) and endoscopic findings (to clarithromycin) were independent factors influencing antibiotic resistance.
CONCLUSION: H. pylori resistance to commonly used antibiotics in Beijing is high with increased multiple antibiotic resistance.
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Abstract
OBJECTIVE To compare the efficacy of sequential therapy, concomitant therapy and hybrid therapy for the treatment of Helicobacter pylori (H. pylori) infection. METHODS PubMed, Web of Science, Medline, Embase, the Cochrane Central Register of Controlled Trials and CNKI were searched up to the end of May 10, 2014 in order to identify all randomized controlled trials (RCTs) reporting the effects of sequential therapy, concomitant therapy and hybrid therapy on H. pylori eradication. The relative risk (RR) of eradicating H. pylori infection after sequential therapy compared with concomitant therapy or hybrid therapy was pooled. The eradication rates were considered both on an intention-to-treat (ITT) and per-protocol (PP) basis. RESULTS A total of 10 RCTs involving 3,501 patients were included. The pooled data suggested that the differences between the three groups were not statistically significant (ITT analysis: sequential therapy vs. concomitant therapy: RR=1.01, 95%confidence interval (CI): 0.97-1.04, sequential therapy vs. hybrid therapy: RR=1.02, 95%CI: 0.85-1.22, concomitant therapy vs. hybrid therapy: RR=1.03, 95%CI: 0.97-1.08; PP analysis: sequential therapy vs. concomitant therapy: RR=1.00, 95%CI: 0.96-1.03, sequential therapy vs. hybrid therapy: RR=0.97, 95%CI: 0.86-1.09, concomitant therapy vs. hybrid therapy: RR=1.01, 95%CI: 0.93-1.10). In the ITT and PP analyses, the overall eradication rates were 84.3% (95%CI: 79.1-89.4) and 86.4% (95%CI: 81.7-91.0) for the sequential therapy group, 86.7% (95%CI: 81.0-92.3) and 89.8% (95%CI: 85.1-94.5) for the concomitant therapy group and 86.6% (95%CI: 82.3-91.0) and 92.7% (95%CI: 90.5-94.9) for the hybrid therapy group, respectively. There were no significant differences among these therapies in terms of the rate of side effects. CONCLUSION The pooled evidence suggests that sequential therapy, concomitant therapy and hybrid therapy are similar with respect to the treatment of H. pylori infection.
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Affiliation(s)
- Lei He
- Department of Gastroenterology, Renmin Hospital of Wuhan University, China
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31
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Kim JH. Recent Update on Third-lineHelicobacter pyloriEradication. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2015. [DOI: 10.7704/kjhugr.2015.15.2.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Ji Hyun Kim
- Department of Gastroenterology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Song Z, Zhang J, He L, Chen M, Hou X, Li Z, Zhou L. Prospective multi-region study on primary antibiotic resistance of Helicobacter pylori strains isolated from Chinese patients. Dig Liver Dis 2014; 46:1077-81. [PMID: 25220697 DOI: 10.1016/j.dld.2014.08.038] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 07/30/2014] [Accepted: 08/19/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Large-scale multi-region studies are urgently needed to provide comprehensive and up-to-date information on the antibiotic resistance of Helicobacter pylori that is critical for selecting the most optimal eradication regimens. AIMS To determine the resistance patterns of Helicobacter pylori strains isolated from dyspeptic patients. METHODS This is a prospective, multicentre, cross-sectional, observational study. Helicobacter pylori cultures were successful in 600 patients (never receiving eradication therapy) from Northern, Eastern, Middle, and Southern regions between 2008 and 2012. Resistance to amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and rifampicin was determined by Epsilometer test. RESULTS The overall resistance rate was highest for metronidazole (403, 67.2%), followed by clarithromycin (225, 37.5%), levofloxacin (201, 33.5%), rifampicin (85, 14.2%), amoxicillin (41, 6.8%), and tetracycline (21, 3.5%). There were 16.3% isolates susceptible to all tested antibiotics, followed by mono-resistance (34.2%), double resistance (27.0%), triple resistance (16.8%), quadruple resistance (4.7%), quintuple resistance (0.7%) and sextuple resistance (0.3%). Independent factors influencing antibiotic resistance were gender (to levofloxacin), age (to levofloxacin), and endoscopic finding (to clarithromycin, metronidazole, and levofloxacin). Among the clarithromycin-resistant isolates, 75.6% and 48.0% were also resistant to metronidazole and levofloxacin, respectively. CONCLUSIONS Helicobacter pylori resistance to commonly used antibiotics in China is a very serious issue, due to the high resistance rate and general multiple resistance.
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Affiliation(s)
- Zhiqiang Song
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Jianzhong Zhang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lihua He
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Minhu Chen
- Department of Gastroenterology, First Affiliated Hospital of SunYat-sen University, Guangzhou, China
| | - Xiaohua Hou
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Technology and Science, Wuhan, China
| | - Zhaoshen Li
- Department of Digestive Diseases, Changhai Hospital of Second Military Medical University, Shanghai, China
| | - Liya Zhou
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China.
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Tu IF, Liao JH, Yang FL, Lin NT, Chan HL, Wu SH. Lon protease affects the RdxA nitroreductase activity and metronidazole susceptibility in Helicobacter pylori. Helicobacter 2014; 19:356-66. [PMID: 24834789 DOI: 10.1111/hel.12140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The lon gene of Helicobacter pylori strains is constitutively expressed during growth. However, virtually nothing is understood concerning the role of Lon in H. pylori. This study examined the function and physiological role of Lon in H. pylori (HpLon) using a trapping approach to identify putative Lon binding partners in the bacterium. MATERIALS AND METHODS Protease-deficient Lon was expressed and served as the bait in trapping approach to capture the interacting partners in H. pylori. The antibiotic susceptibility of wild-type and lon derivative mutants was determined by the E test trips and the disc diffusion assay. The effect of HpLon on RdxA activity was detected the change in NADPH oxidation and metronidazole reduction by spectrophotometer. RESULTS Lon in Helicobacter pylori (HpLon) interacting partners are mostly associated with metronidazole activation. lon mutant presents more susceptible to metronidazole than that of the wild type, and this phenotype is recovered by complementation of the wild-type Lon. We found that the ATPases associated with a variety of cellular activities (AAA(+) ) module of HpLon causes a decrease in both NADPH oxidase and Mtz reductase activity in RdxA, a major Mtz-activating enzyme in H. pylori. CONCLUSION Metronidazole resistance of H. pylori causes the serious medical problem worldwide. In this study, HpLon is involved in metronidazole susceptibility among H. pylori strains. We provide the evidence that HpLon alters RdxA activity in vitro. The decrease in metronidazole activation caused by HpLon is possibly prior to accumulate mutation in rdxA gene before the metronidazole-resistant strains to be occurred.
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Affiliation(s)
- I-Fan Tu
- Institute of Bioinformatics and Structural Biology, National Tsing Hua University, Hsinchu, 300, Taiwan
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Lee JY, Kim N. [Future trends of Helicobacter pylori eradication therapy in Korea]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 63:158-70. [PMID: 24651589 DOI: 10.4166/kjg.2014.63.3.158] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The prevalence of Helicobacter pylori infection in Korea shows a decreasing trend and has changed to that of developed country, especially for those below 30 years old. However, the primary antibiotic resistance rates are higher than those of developed countries. The reason for the decrease in the efficacy of standard triple therapy is mainly due to the increase in the resistance against clarithromycin. Sequential therapy seems to be more effective than the standard triple therapy, but the intention-to-treat eradication rate of sequential therapy in Korea, which is mostly under 80.0%, is still not satisfactory. Therefore, a promising regimen is needed. Recently, the Japanese health insurance system admitted 'H. pylori-infected gastritis'as an indication of eradication. Furthermore, the Kyoto Consensus Meeting on H. pylori Gastritis held from January 30th to February 1st, 2014, proposed that 'all H. pylori positive patients should be offered to receive H. pylori eradication'. This suggests that the concept of eradication has been changed from 'treatment' to 'prevention'. Various individualized tailored therapy based on the polymorphism, age and other demographic factors and antibiotic resistance has been attempted to maximize H. pylori eradication therapy. The aim of this article is to review the current epidemiology, H. pylori resistance state, treatment guideline, and to assess the possible future strategy and treatment for H. pylori infection in Korea.
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Affiliation(s)
- Ju Yup Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173beon-gil, Bundang-gu, Seongnam 463-707, Korea
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Graham DY, Lee YC, Wu MS. Rational Helicobacter pylori therapy: evidence-based medicine rather than medicine-based evidence. Clin Gastroenterol Hepatol 2014; 12:177-86.e3; Discussion e12-3. [PMID: 23751282 PMCID: PMC3830667 DOI: 10.1016/j.cgh.2013.05.028] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 05/07/2013] [Accepted: 05/15/2013] [Indexed: 02/07/2023]
Abstract
Data are available such that choice of Helicobacter pylori therapy for an individual patient can be reliably predicted. Here, treatment success is defined as a cure rate of 90% or greater. Treatment outcome in a population or a patient can be calculated based on the effectiveness of a regimen for infections with susceptible and with resistant strains coupled with the knowledge of the prevalence of resistance (ie, based on formal measurement, clinical experience, or both). We provide the formula for predicting outcome and we illustrate the calculations. Because clarithromycin-containing triple therapy and 10-day sequential therapy are now only effective in special populations, they are considered obsolete; neither should continue to be used as empiric therapies (ie, 7- and 14-day triple therapies fail when clarithromycin resistance exceeds 5% and 15%, respectively, and 10-day sequential therapy fails when metronidazole resistance exceeds 20%). Therapy should be individualized based on prior history and whether the patient is in a high-risk group for resistance. The preferred choices for Western countries are 14-day concomitant therapy, 14-day bismuth quadruple therapy, and 14-day hybrid sequential-concomitant therapy. We also provide details regarding the successful use of fluoroquinolone-, rifabutin-, and furazolidone-containing therapies. Finally, we provide recommendations for the efficient development (ie, identification and optimization) of new regimens, as well as how to prevent or minimize failures. The trial-and-error approach for identifying and testing regimens frequently resulted in poor treatment success. The described approach allows outcome to be predicted and should simplify treatment and drug development.
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Affiliation(s)
- David Y Graham
- Department of Medicine, Michael E. DeBakey VA Medical Center, and Baylor College of Medicine, Houston, Texas.
| | - Yi-Chia Lee
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Levofloxacin-based first-line therapy versus standard first-line therapy for Helicobacter pylori eradication: meta-analysis of randomized controlled trials. PLoS One 2014; 9:e85620. [PMID: 24465624 PMCID: PMC3897467 DOI: 10.1371/journal.pone.0085620] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 12/06/2013] [Indexed: 02/08/2023] Open
Abstract
Background First-line levofloxacin-based treatments eradicate Helicobacter pylori with varying success. We examined the efficacy and safety of first-line levofloxacin-based treatment in comparison to standard first-line therapy for H pylori eradication. Materials and Methods We searched literature databases from Medline, EMBASE, and the Cochrane Register of Randomized Controlled Trials through March 2013 for randomized controlled trials comparing first-line levofloxacin and standard therapy. We included randomized controlled trials conducted only on naïve H pylori infected patients in adults. A systematic review was conducted. Meta-analysis was performed with Review Manager 5.2. Treatment effect was determined by relative risk with a random or fixed model by the Mantel-Haenszel method. Results Seven trials were identified with 888 patients receiving 7 days of first-line levofloxacin and 894 treated with standard therapy (Amoxicillin, Clarithromycin and proton pump inhibitor) for 7 days. The overall crude eradication rate in the Levofloxacin group was 79.05% versus 81.4% in the standard group (risk ratio 0.97; 95% CI; 0.93, 1.02). The overall dropout was 46 (5.2%) in the levofloxacin group and 52 (5.8%) for standard therapy. The dizziness was more common among group who took Levofloxacin based treatment and taste disturbance was more common among group who took standard therapy. Meta-analysis of overall adverse events were similar between the two groups with a relative risk of 1.06 (95% CI 0.72, 1.57). Conclusion Helicobacter pylori eradication with 7 days of Levofloxacin-based first line therapy was safe and equal compared to 7 days of standard first-line therapy.
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Kim SY, Park DK, Kwon KA, Kim KO, Kim YJ, Chung JW. Ten Day Concomitant Therapy Is Superior to Ten Day Sequential Therapy forHelicobacter pyloriEradication. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 64:260-7. [DOI: 10.4166/kjg.2014.64.5.260] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Su Young Kim
- Department of Gastroenterology, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Kyun Park
- Department of Gastroenterology, Gachon University Gil Medical Center, Incheon, Korea
| | - Kwang An Kwon
- Department of Gastroenterology, Gachon University Gil Medical Center, Incheon, Korea
| | - Kyoung Oh Kim
- Department of Gastroenterology, Gachon University Gil Medical Center, Incheon, Korea
| | - Yoon Jae Kim
- Department of Gastroenterology, Gachon University Gil Medical Center, Incheon, Korea
| | - Jun Won Chung
- Department of Gastroenterology, Gachon University Gil Medical Center, Incheon, Korea
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Yoon H, Lee DH, Kim N, Park YS, Shin CM, Kang KK, Oh DH, Jang DK, Chung JW. Meta-analysis: is sequential therapy superior to standard triple therapy for Helicobacter pylori infection in Asian adults? J Gastroenterol Hepatol 2013; 28:1801-9. [PMID: 24118110 DOI: 10.1111/jgh.12397] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Although several meta-analyses suggested that sequential therapy (SQT) is superior to standard triple therapy (STT) for the eradication of Helicobacter pylori, these results were mainly based on the studies from Italy. The aim of this study was to assess the efficacy of 10-day SQT for H. pylori infection compared with STT in Asian adults. METHODS We performed an electronic search of the Cochrane Library, Medline, and Embase up to April 21, 2013, with no language restrictions. Randomized controlled trials comparing 10-day SQT with STT for H. pylori eradication in Asian adults were included in this analysis. The primary outcome measures were the risk ratios (RRs) for successful eradication of H. pylori based on intention to treat comparing SQT with STT. The secondary outcome measures were the RRs for side effects. RESULTS Seventeen randomized controlled trials with a total of 3419 participants (1591 for SQT and 1828 for STT) met the inclusion criteria. The eradication rate was 81.8% (95% CI: 78.9-84.6) for SQT and 74.3% (95% CI: 69.6-78.8) for SST, respectively. The pooled RR was 1.10 (95% CI: 1.04-1.16, P = 0.0005), which demonstrated significant superiority of SQT over STT, and the number needed to treat was 14 (95% CI: 9-29). There were no significant differences between SQT and STT in the risk of side effects (the pooled RR: 0.98, 95% CI: 0.87-1.10, P = 0.73). CONCLUSION Ten-day SQT appears to be superior to STT for H. pylori eradication in Asian adults. However, the pooled efficacy is lower than results from earlier European studies.
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Affiliation(s)
- Hyuk Yoon
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
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Su P, Li Y, Li H, Zhang J, Lin L, Wang Q, Guo F, Ji Z, Mao J, Tang W, Shi Z, Shao W, Mao J, Zhu X, Zhang X, Tong Y, Tu H, Jiang M, Wang Z, Jin F, Yang N, Zhang J. Antibiotic resistance of Helicobacter pylori isolated in the Southeast Coastal Region of China. Helicobacter 2013; 18:274-9. [PMID: 23418857 DOI: 10.1111/hel.12046] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The resistance of Helicobacter pylori (H. pylori) to antibiotics is increasing worldwide, lowering its efficacy in current eradication therapies. This study evaluated H. pylori resistance to antibiotics in the southeast coastal region of China and suggests appropriate alternatives. MATERIALS AND METHODS Seventeen thousand seven hundred and thirty one H. pylori strains were collected from eight areas of two provinces in coastal southeast China from 2010 to 2012. The resistance of these strains to six antibiotics was tested using the agar dilution method. RESULTS The resistance rates to clarithromycin, metronidazole, levofloxacin, amoxicillin, gentamicin and furazolidone were 21.5, 95.4, 20.6, 0.1, 0.1 and 0.1%, respectively. Double, triple and quadruple antibacterial resistant percentages were 25.5, 7.5 and 0.1%, respectively. A positive association between the resistance to levofloxacin and to clarithromycin was found, but there was a negative correlation in the resistances to levofloxacin and to metronidazole. CONCLUSIONS The prevalence of H. pylori resistance to clarithromycin, metronidazole, levofloxacin and multiple antibiotics in coastal southeast China is high. Choice of therapy should be individualized based on a susceptibility test in this region of the country.
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Affiliation(s)
- Peng Su
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Zhang G, Zou J, Liu F, Bao Z, Dong F, Huang Y, Yin S. The efficacy of moxifloxacin-based triple therapy in treatment of Helicobacter pylori infection: a systematic review and meta-analysis of randomized clinical trials. Braz J Med Biol Res 2013; 46:607-13. [PMID: 23903685 PMCID: PMC3859334 DOI: 10.1590/1414-431x20132817] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 04/25/2013] [Indexed: 12/18/2022] Open
Abstract
Recent evidence shows that moxifloxacin could exert an antimicrobial effect
against Helicobacter pylori in both in vitro
and in vivo models. To systematically evaluate whether
moxifloxacin-containing triple therapy could improve eradication rates and
reduce side effects in first-line or second-line anti-H. pylori
treatment, eligible articles were identified by searches of electronic
databases. We included all randomized trials comparing moxifloxacin-based triple
therapy with standard triple or quadruple therapy during H.
pylori eradication treatment. Statistical analysis was performed
with Review Manager 5.0.10. Subanalysis/sensitivity analysis was also performed.
We identified seven randomized trials (n=1263). Pooled H.
pylori eradication rates were 79.03% (95%CI: 75.73-82.07) and
68.33% (95%CI: 64.44-72.04) for patients with moxifloxacin-based triple therapy
or with standard triple or quadruple therapy, respectively (intention-to-treat
analysis). The odds ratio (OR) was 1.82 (95%CI: 1.17-2.81), the occurrence of
total side effects was 15.23% (95%CI: 12.58-18.20) and 27.17% (95%CI:
23.64-30.92) for groups with or without moxifloxacin, and the summary OR was
0.45 (95%CI: 0.26-0.77). In subgroup analyses, we noted that the second-line
eradication rate in the moxifloxacin group was significantly higher than that in
the quadruple therapy group (73.33 vs 60.17%, OR: 1.78, 95%CI:
1.16-2.73, P<0.001). However, there was no difference in first-line
eradication treatment. Findings from this meta-analysis suggest that
moxifloxacin-based triple therapy is more effective and better tolerated than
standard triple or quadruple therapy. Therefore, a moxifloxacin-based triple
regimen should be used in the second-line treatment of H.
pylori infection.
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Affiliation(s)
- G Zhang
- Department of Gastroenterology, Huadong Hospital, Fudan University, Shanghai, China
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Selgrad M, Bornschein J, Malfertheiner P. Guidelines for treatment of Helicobacter pylori in the East and West. Expert Rev Anti Infect Ther 2013; 9:581-8. [PMID: 21819326 DOI: 10.1586/eri.11.80] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Infection with Helicobacter pylori remains a major healthcare burden, with persistently high prevalence rates, especially in less-developed countries. H. pylori infection is causally related to non-malignant and malignant gastroduodenal diseases, such as peptic ulcer diseases, gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma. Current international guidelines recommend a standard triple therapy as first-line therapy, including a proton pump inhibitor and a combination of amoxicillin and clarithromycin. Standard triple therapy has shown a decreasing efficacy over the years. The main reason is the increasing antibiotic resistance, particular to clarithromycin of H. pylori strains. Several new treatment options or modifications of already established regimens have been introduced to overcome treatment failure. In this article, we intend to report the reasons for treatment failure, and furthermore we give an overview of new treatment options as alternatives to the current treatment regimens. Finally, the strategy for the future is considered.
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Affiliation(s)
- Michael Selgrad
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
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Lee JW, Kim N, Kim JM, Nam RH, Chang H, Kim JY, Shin CM, Park YS, Lee DH, Jung HC. Prevalence of primary and secondary antimicrobial resistance of Helicobacter pylori in Korea from 2003 through 2012. Helicobacter 2013; 18:206-14. [PMID: 23241101 DOI: 10.1111/hel.12031] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Antimicrobial resistance of Helicobacter pylori (H. pylori) affects the efficacy of eradication therapy. The aim of this study was to estimate the prevalence of primary and secondary resistance of H. pylori isolates to antibiotics and to characterize the risk factors associated with antimicrobial resistance in Korea. MATERIALS AND METHODS This study was performed during the period of 2003-2012. Primary resistance was evaluated from 347 patients without any history of eradication, and secondary resistance was evaluated in 86 patients from whom H. pylori was cultured after failure of eradication. Minimal inhibitory concentration test was performed for amoxicillin, clarithromycin, metronidazole, tetracycline, azithromycin, levofloxacin, and moxifloxacin using agar dilution method. Primary and secondary resistance rates of H. pylori to 7 antibiotics were evaluated and risk factors for the antibiotic resistance were analyzed. RESULTS Increase in the primary resistance rate was found in amoxicillin (6.3-14.9%, p = .051), clarithromycin (17.2-23.7%, p = .323), and both of levofloxacin and moxifloxacin (4.7-28.1%, p = .002) during the study period. Secondary resistance rate significantly increased in metronidazole, levofloxacin, and moxifloxacin. Increase of resistance occurred after initial failure of eradication therapy in case of clarithromycin (p < .001), azithromycin (p < .001), levofloxacin (p = .011), and moxifloxacin (p = .020). Multivariable analyses showed that clarithromycin, azithromycin, levofloxacin, and moxifloxacin resistance was associated with previous eradication treatment history. CONCLUSIONS The increased primary and secondary antibiotic resistance of H. pylori in Korea is ongoing, and it will become a significant limitation for effective eradication of H. pylori in the future.
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Affiliation(s)
- Jung Won Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
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Zullo A, Severi C, Vannella L, Hassan C, Sbrozzi-Vanni A, Annibale B. Role of gastritis pattern on Helicobacter pylori eradication. Intern Emerg Med 2012; 7:517-22. [PMID: 22105372 DOI: 10.1007/s11739-011-0730-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 11/08/2011] [Indexed: 02/05/2023]
Abstract
Helicobacter pylori eradication rate following standard triple therapy is decreasing. Identification of predictive factors of therapy success would be useful for H. pylori management in clinical practice. This study aimed to evaluate the role of different gastritis patterns on the efficacy of the currently suggested 14-day triple therapy regimen. One-hundred and seventeen, consecutive, non-ulcer dyspeptic patients, with H. pylori infection diagnosed at endoscopy, were enrolled. All patients received a 14-day, triple therapy with lansoprazole 30 mg, clarithromycin 500 mg and amoxicillin 1 g, all given twice daily. Bacterial eradication was assessed with (13)C-urea breath test 4-6 weeks after completion of therapy. H. pylori infection was cured in 70.1% at ITT analysis and 83.7% at PP analysis. The eradication rate tended to be lower in patients with corpus-predominant gastritis as compared to those with antral-predominant gastritis at both ITT (66.1 vs 74.5%) and PP (80.4 vs 87.2%) analyses. The multivariate analysis failed to identify factors associated with therapy success. However, 14-day triple therapy does not achieve acceptable H. pylori cure rate in Italy, and should be not recommended in clinical practice.
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Affiliation(s)
- Angelo Zullo
- Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.
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Caro SD, Fini L, Daoud Y, Grizzi F, Gasbarrini A, Lorenzo AD, Renzo LD, McCartney S, Bloom S. Levofloxacin/amoxicillin-based schemes vs quadruple therapy for Helicobacter pylori eradication in second-line. World J Gastroenterol 2012; 18:5669-78. [PMID: 23155306 PMCID: PMC3484334 DOI: 10.3748/wjg.v18.i40.5669] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 05/29/2012] [Accepted: 06/08/2012] [Indexed: 02/06/2023] Open
Abstract
Worldwide prevalence of Helicobacter pylori (H. pylori) infection is approximately 50%, with the highest being in developing countries. We compared cure rates and tolerability (SE) of second-line anti-H. pylori levofloxacin/amoxicillin (LA)-based triple regimens vs standard quadruple therapy (QT). An English language literature search was performed up to October 2010. A meta-analysis was performed including randomized clinical trials comparing 7- or 10-d LA with 7-d QT. In total, 10 articles and four abstracts were identified. Overall eradication rate in LA was 76.5% (95% CI: 64.4%-97.6%). When only 7-d regimens were included, cure rate was 70.6% (95% CI: 40.2%-99.1%), whereas for 10-d combinations, cure rate was significantly higher (88.7%; 95% CI: 56.1%-109.9%; P < 0.05). Main eradication rate for QT was 67.4% (95% CI: 49.7%-67.9%). The 7-d LA and QT showed comparable efficacy [odds ratio (OR): 1.09; 95% CI: 0.63-1.87], whereas the 10-d LA regimen was significantly more effective than QT (OR: 5.05; 95% CI: 2.74-9.31; P < 0.001; I2 = 75%). No differences were reported in QT eradication rates among Asian and European studies, whereas LA regimens were more effective in European populations (78.3% vs 67.7%; P = 0.05). Incidence of SE was lower in LA therapy than QT (OR: 0.39; 95% CI: 0.18-0.85; P = 0.02). A higher rate of side effects was reported in Asian patients who received QT. Our findings support the use of 10-d LA as a simple second-line treatment for H. pylori eradication with an excellent eradication rate and tolerability. The optimal second-line alternative scheme might differ among countries depending on quinolone resistance.
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Sereni G, Azzolini F, Camellini L, Formisano D, Decembrino F, Iori V, Tioli C, Cavina M, Di Mario F, Bedogni G, Sassatelli R. Efficacy of a therapeutic strategy for eradication of Helicobacter pylori infection. World J Gastroenterol 2012; 18:4542-8. [PMID: 22969227 PMCID: PMC3435779 DOI: 10.3748/wjg.v18.i33.4542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 04/16/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the efficacy of our therapeutic strategy for Helicobacter pylori (H. pylori) eradication and to identify predictive factors for successful eradication.
METHODS: From April 2006 to June 2010, we retrospectively assessed 2428 consecutive patients (1025 men, 1403 women; mean age 55 years, age range 18-92 years) with gastric histology positive for H. pylori infection referred to our unit for 13-C urea breath test (UBT), after first-line therapy with proton pump inhibitor (PPI) b.i.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 d. Patients who were still positive to UBT were recommended a second-line therapy (PPI b.i.d. + amoxicillin 1 g b.i.d. + tinidazole 500 mg b.i.d. for 14 d). Third choice treatment was empirical with PPI b.i.d. + amoxicillin 1 g b.i.d. + levofloxacin 250 mg b.i.d. for 14 d.
RESULTS: Out of 614 patients, still H. pylori-positive after first-line therapy, only 326 and 19 patients respectively rechecked their H. pylori status by UBT after the suggested second and third-line regimens. “Per protocol” eradication rates for first, second and third-line therapy were 74.7% (95% CI: 72.7%-76.4%), 85.3% (95% CI: 81.1%-89.1%) and 89.5% (95% CI: 74.9%-103%) respectively. The overall percentage of patients with H. pylori eradicated after two treatments was 97.8% (95% CI: 97.1%-98.4%), vs 99.9% (95% CI: 99.8%-100%) after three treatments. The study found that eradication therapy was most effective in patients with ulcer disease (P < 0.05, P = 0.028), especially in those with duodenal ulcer. Smoking habits did not significantly affect the eradication rate.
CONCLUSION: First-line therapy with amoxicillin and clarithromycin produces an H. pylori eradication rate comparable or superior to other studies and second-line treatment can still be triple therapy with amoxicillin and tinidazole.
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Chang WL, Kao CY, Wu CT, Huang AH, Wu JJ, Yang HB, Cheng HC, Sheu BS. Gemifloxacin can partially overcome quinolone resistance of H. pylori with gyrA mutation in Taiwan. Helicobacter 2012; 17:210-5. [PMID: 22515359 DOI: 10.1111/j.1523-5378.2012.00935.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUNDS The levofloxacin resistance caused by gyrA gene mutation is rising rapidly to limit wide application for Helicobacter pylori eradication. We investigated whether gemifloxacin has a superior antimicrobial activity to levofloxacin against H. pylori. MATERIALS AND METHODS Forty-four consecutive clinical H. pylori isolates with levofloxacin resistance and 80 randomly selected levofloxacin-sensitive controls were tested for gemifloxacin sensitivity by E-test. The resistance to levofloxacin or gemifloxacin was defined as minimal inhibitory concentration (MIC) > 1 mg/L. The clinical features and GyrA mutation patterns checked by direct sequencing were also analyzed to assess its association with the H. pylori gemifloxacin resistance. RESULTS All levofloxacin-sensitive H. pylori isolates were sensitive to gemifloxacin. Eight strains (18.2%) resistant to levofloxacin could be still sensitive to gemifloxacin. Gemifloxacin achieved a 5-time lower in MIC levels against levofloxacin-resistant isolates. Nearly all levofloxacin-resistant isolates (97.7%, 43/44) had GyrA mutation at amino acid position 87 or 91. Double mutation sites may play dual roles in quinolone resistance, as N87K plus H57Y or D91N plus V77A mutations showed high-level resistance to both quinolones; whereas D91Y plus A97V or D91N plus A97V mutations showed low level levofloxacin resistance to become sensitive to gemifloxacin. In H. pylori isolates with single N87K, D91Y or D91N mutation, near 20% was gemifloxacin-sensitive and levofloxacin-resistant. The gemifloxacin-resistant rate of H. pylori was higher in patients with gastric ulcer than in those without (p <.05). CONCLUSION Gemifloxacin is superior to levofloxacin in antimicrobial activity against clinical H. pylori isolates, and even overcome some levofloxacin resistance.
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Affiliation(s)
- Wei-Lun Chang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Chung JW, Lee GH, Jeong JY, Lee SM, Jung JH, Choi KD, Song HJ, Jung HY, Kim JH. Resistance of Helicobacter pylori strains to antibiotics in Korea with a focus on fluoroquinolone resistance. J Gastroenterol Hepatol 2012; 27:493-7. [PMID: 21793912 DOI: 10.1111/j.1440-1746.2011.06874.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM New regimens, including those with new fluoroquinolones, have been developed to overcome the antibiotic resistance of Helicobacter pylori. We aimed to assess the antibiotic resistance rates, as well as the molecular mechanisms of fluoroquinolone resistance, of the clinical isolates obtained in Korea. METHODS The minimal inhibitory concentration (MIC) values of ciprofloxacin, amoxicillin, clarithromycin, metronidazole and tetracycline were determined by the agar dilution method for 185 treatment-naïve Helicobacter pylori isolates. The resistant strains were evaluated for the presence of point mutations in the quinolone resistance-determining region (QRDR) of the gyrA and gyrB genes by direct nucleotide sequencing. RESULTS Twenty-nine (29/185, 15.7%) of the strains were found to be resistant to ciprofloxacin. The resistance rates to amoxicillin, clarithromycin, metronidazole and tetracycline were 2.2% (four of 185), 10.8% (20 of 185), 30.3% (56 of 185) and 0.5% (one of 185), respectively. The most common mutations in the H. pylori gyrA gene were found at codons corresponding to Asp87 (16/29, 55.2%) and Asn91 (10/29, 34.5%). CONCLUSIONS Primary H. pylori resistance to ciprofloxacin occurred at a high frequency. The fluoroquinolone resistance is most likely mediated through amino acid point mutation in the gyrA gene at Asn87 and Asp91.
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Affiliation(s)
- Jun-Won Chung
- Department of Internal Medicine, Gachon Graduate School of Medicine, Gil Medical Center, Incheon, Korea
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Gisbert JP. Rescue Therapy for Helicobacter pylori Infection 2012. Gastroenterol Res Pract 2012; 2012:974594. [PMID: 22536225 PMCID: PMC3299261 DOI: 10.1155/2012/974594] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 12/10/2011] [Indexed: 12/18/2022] Open
Abstract
Helicobacter pylori infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. After 30 years of experience in H. pylori treatment, however, the ideal regimen to treat this infection has still to be found. Nowadays, apart from having to know well first-line eradication regimens, we must also be prepared to face treatment failures. In designing a treatment strategy, we should not only focus on the results of primary therapy alone but also on the final-overall-eradication rate. The choice of a "rescue" treatment depends on which treatment is used initially. If a first-line clarithromycin-based regimen was used, a second-line metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacin-based combination would be a third-line "rescue" option. Alternatively, it has recently been suggested that levofloxacin-based "rescue" therapy constitutes an encouraging 2nd-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, quadruple regimen may be reserved as a 3rd-line "rescue" option. Even after two consecutive failures, several studies have demonstrated that H. pylori eradication can finally be achieved in almost all patients if several "rescue" therapies are consecutively given.
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Affiliation(s)
- Javier P. Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
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Karczewska E, Wojtas-Bonior I, Sito E, Zwolińska-Wcisło M, Budak A. Primary and secondary clarithromycin, metronidazole, amoxicillin and levofloxacin resistance to Helicobacter pylori in southern Poland. Pharmacol Rep 2011; 63:799-807. [PMID: 21857091 DOI: 10.1016/s1734-1140(11)70592-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 12/21/2010] [Indexed: 12/14/2022]
Abstract
The aim of this study was to assess the primary and secondary resistance of H. pylori strains cultured from adult patients of the Małopolska region of Poland, mainly of Kraków and the surrounding areas, to antibacterial agents (amoxicillin, clarithromycin, metronidazole and levofloxacin). In total, 115 H. pylori strains were isolated, of which 90 strains originated from patients who had never been treated for H. pylori infection, while the remaining 25 were isolated from patients in whom eradication of the infection failed after treatment. All tested H. pylori strains were susceptible to amoxicillin. Forty-four percent of strains isolated were resistant to metronidazole. The primary and secondary resistance to this antimicrobial chemotherapeutic reached 37% and 72% (p = 0.002), respectively. In total, 34% of strains were resistant to clarithromycin, and the ratio of strains with secondary resistance was significantly greater than that of the strains with primary resistance (80% vs. 21%, p < 0.001). The double resistance to both metronidazole and clarithromycin was confirmed in 23% of H. pylori strains. Five percent of H. pylori strains were resistant to levofloxacin, while primary and secondary resistance to this drug accounted for 2% and 16% (p = 0.006), respectively. In total, 4% of H. pylori strains were simultaneously resistant to metronidazole, clarithromycin and levofloxacin. Thus, the high resistance to metronidazole and clarithromycin excludes the possibility of using these drugs for treatment of H. pylori infection without earlier antibiogramming. Levofloxacin, as a drug of high efficacy against H. pylori, should be reserved for an "emergency" therapy and used in a limited capacity in order to preserve its potent antimicrobial activity. The Polish Society of Gastroenterology recommends levofloxacin as a third-line therapy.
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Affiliation(s)
- Elżbieta Karczewska
- Department of Pharmaceutical Microbiology of the Jagiellonian University Medical College, Medyczna 9, PL 30-688 Kraków, Poland.
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Miehlke S, Krasz S, Schneider-Brachert W, Kuhlisch E, Berning M, Madisch A, Laass MW, Neumeyer M, Jebens C, Zekorn C, Knoth H, Vieth M, Stolte M, Lehn N, Morgner A. Randomized trial on 14 versus 7 days of esomeprazole, moxifloxacin, and amoxicillin for second-line or rescue treatment of Helicobacter pylori infection. Helicobacter 2011; 16:420-6. [PMID: 22059392 DOI: 10.1111/j.1523-5378.2011.00867.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Triple therapy with a proton pump inhibitor, moxifloxacin, and amoxicillin has been proven effective in first-line treatment of Helicobacter pylori infection. AIM To explore 1, the value of triple therapy with esomeprazole, moxifloxacin, and amoxicillin in second-line or rescue treatment of Caucasian patients and 2, the impact of treatment duration on eradication success. METHODS H. pylori-infected patients with at least one previous treatment failure were randomized to oral esomeprazole 20 mg b.i.d., moxifloxacin 400 mg o.d., and amoxicillin 1000 mg b.i.d. for either 7 (EMA-7) or 14 days (EMA-14). Eradication was confirmed by 13C urea breath test. Antimicrobial susceptibility testing was performed in all patients at baseline and in patients who failed treatment. RESULTS Eighty patients were randomized, and 60% had ≥ 2 previous treatment failures. Pretreatment resistance against clarithromycin and metronidazole was found in 70.5 and 61.5% of cases, respectively. The intention-to-treat eradication rate was significantly higher after EMA-14 compared with EMA-7 (95.0 vs 78.9%, p = .036). No independent risk factor for treatment failure could be identified. There were no serious adverse events. Five of the EMA-14 patients (12.5%) compared with none of the EMA-7 patients discontinued prematurely because of adverse events (p = .031). Post-treatment resistance against moxifloxacin was found in one of seven patients with isolated organisms (14.3%). CONCLUSION Second-line/rescue H. pylori eradication therapy with esomeprazole, moxifloxacin, and amoxicillin is very effective and well tolerated. Fourteen days of treatment significantly increase the eradication rate but also the rate of adverse events.
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Affiliation(s)
- Stephan Miehlke
- Center for Digestive Diseases, Cooperation of Internal Medicine, Hamburg, Germany.
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