The impact of Helicobacter pylori resistance on the efficacy of a short course pantoprazole based triple therapy

Abstract

-Background -Many of the currently used Helicobacter pylori eradication regimens fail to cure the infection due to either antimicrobial resistance or poor patient compliance. Those patients will remain at risk of developing potentially severe complications of peptic ulcer disease. Aim -We studied the impact of the antimicrobial resistance on the efficacy of a short course pantoprazole based triple therapy in a single-center pilot study. Methods -Forty previously untreated adult patients (age range 20 to 75 years, 14 males) infected with Helicobacter pylori and with inactive or healing duodenal ulcer disease were assigned in this open cohort study to 1 week twice daily treatment with pantoprazole 40 mg, plus clarithromycin 250 mg and metronidazole 400 mg. Helicobacter pylori was assessed at entry and 50 ± 3 days after the end of treatment by rapid urease test, culture and histology of gastric biopsies. The criteria for eradication was a negative result in the tests. Susceptibility of Helicobacter pylori to clarithromycin and metronidazole was determined before treatment with the disk diffusion test. Results -One week treatment and follow up were complete in all patients. Eradication of Helicobacter pylori was achieved in 35/40 patients (87.5%) and was higher in patients with nitroimidazole-susceptible strains [susceptible: 20/20 (100%), resistant: 10/ 15 (67%)]. There were six (15%) mild adverse events reports. Conclusions -A short course of pantoprazole-based triple therapy is well tolerated and effective in eradicating Helicobacter pylori. The baseline metronidazole resistance may be a significant limiting factor in treatment success.

Meta‐analysis: the effect of antibiotic resistance status on the efficacy of triple and quadruple first‐line therapies for Helicobacter pylori

“… ANB, 27–32 0, NTB, 27, 33–45 ANG, 33, 40 38, 41, 46–66 CNG, 22, 31, 53, 54, 57, 60–64, 67–90 ACG, 38, 59, 62, 63, 67, 70, 78, 84, 87, 91–105 MTBG, 34, 38, 39, 58, 99, 106–116 ACMG 82, 117 and CMBR 31, 67, 111, 113, 118 …”

“…Clarithromycin, nitroimidazole and a gastric acid inhibitor The most commonly tested regimen in our analysis treated 3128 subjects with clarithromycin, a nitroimidazole and a gastric acid inhibitor (CNG; Table 1). CNG treatment arms came from studies conducted in North America (two studies, 11 arms), South America (one study, two arms), Europe (21 studies, 58 arms), Asia (nine studies, 24 arms) and Australia (one study, four arms) 22, 31, 53, 54, 57, 60–64, 67–90 . The duration of CNG treatment ranged from 5 to 14 days.…”

Clarithromycin-based triple therapy for Helicobacter pylori treatment in peptic ulcer patients

“…Second-and third-generation macrolides have been commercially available for a long time, but they are not used widely due to their elevated cost, a fact which may suffice to explain these low resistance rates in our country. Conversely, the widespread use of nitroimidazolic compounds to treat parasitic infections, sexually transmitted diseases, and gynecological infections might be responsible for the significant reduction in H. pylori metronidazole sensitivity as several authors have observed [11,12,25,[36][37][38][39]41].…”

Quadruple therapy with furazolidone for retreatment in patients with peptic ulcer disease

“…The efficacy of different regimens varies according to patient compliance and bacterial resistance to the antibiotics [13] . Clarithromycyn, quinolones and metronidazole should not be used more than once, due to H pylori intrinsic or induced resistance [14,15] .…”