Antibiotics resistance of Helicobacter pylori in children with upper gastrointestinal symptoms in Hangzhou, China

Shu, Xiaoli; Yin, Guofeng; Liu, Mingnan; Peng, Kui; Zhao, Hong; Jiang, Mizu

doi:10.1111/hel.12481

Cited by 22 publications

(26 citation statements)

References 14 publications

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“…With the exception of Iran where furazolidone-resistant H. pylori is common (5% to 22%), the reported resistance rates in China, Vietnam, and United States are consistently < 5%[ 2 , 11 , 23 , 27 - 30 ]. A recent local study examining 545 H. pylori cultures obtained from children showed absence of furazolidone-resistant H. pylori , consistent with the low (4%) resistance rate shown at our center[ 29 ]. In addition to the low prevalence of furazolidone-resistant H. pylori (< 5%), amoxicillin as the backbone of eradication therapy continues to have the lowest prevalence of H. pylori resistance reported globally (< 1%-2%) and in China (< 5%).…”

Section: Discussionsupporting

confidence: 88%

“…Furthermore, H. pylori culture and sensitivity were not performed in all enrolled patients. However, H. pylori antibiotic sensitivity data available in a subset of patients in our study paralleled findings from two recent large studies from the same region[ 29 , 49 ]. Finally, the analysis of patients who completed repeat evaluation of H. pylori after treatment may lead to bias in the interpretation of the results.…”

Section: Discussionsupporting

confidence: 86%

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Outcomes of furazolidone- and amoxicillin-based quadruple therapy forHelicobacter pyloriinfection and predictors of failed eradication

Zhang¹,

Hu²,

Cai³

et al. 2018

WJG

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AIMTo evaluate the outcomes of furazolidone- and amoxicillin-based quadruple therapy for treatment of Helicobacter pylori (H. pylori) infection and identify predictors of failed eradication.METHODSPatients with H. pylori infection treated with furazolidone, amoxicillin, bismuth, and proton pump inhibitor therapy (January 2015 to December 2015) who received the 13C-urea breath test > 4 wk after treatment were evaluated. Demographic and clinical data including prior H. pylori treatment attempts, medication adherence, alcohol and cigarette consumption during therapy, and treatment-related adverse events were recorded by reviewing medical records and telephone surveys. H. pylori eradication rates for overall and subgroups were evaluated. Multivariate analysis was performed to identify independent predictors of failed H. pylori eradication.RESULTSOf the 992 patients treated and retested for H. pylori infection, the overall eradication rate was 94.5% [95% confidence interval (CI): 94.1%-95.9%]. H. pylori eradication rate of primary therapy was 95.0% (95%CI: 93.5%-96.5%), while that of rescue therapy was 91.3% (95%CI: 86.8%-95.8%). Among the 859 patients who completed the study protocol, 144 (17%) reported treatment-related adverse events including 24 (3%) leading to premature discontinuation. On multivariate analysis, poor medication adherence [adjusted odds ratio (AOR) = 6.7, 95%CI: 2.8-15.8], two or more previous H. pylori treatments (AOR = 7.4, 95%CI: 2.2-24.9), alcohol consumption during therapy (AOR = 4.4, 95%CI: 1.5-12.3), and possibly smoking during therapy (AOR = 1.9, 95%CI: 0.9-4.3) were associated with failed H. pylori eradication.CONCLUSIONFurazolidone- and amoxicillin-based quadruple therapy for H. pylori infection in an area with a high prevalence of clarithromycin resistance demonstrated high eradication rates as primary and rescue therapies with a favorable safety profile. Patient education targeting abstinence from alcohol during therapy and strict medication adherence may further optimize H. pylori eradication.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 86%

Outcomes of furazolidone- and amoxicillin-based quadruple therapy forHelicobacter pyloriinfection and predictors of failed eradication

Zhang¹,

Hu²,

Cai³

et al. 2018

WJG

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“…7 We also found that the total resistance rates of H. pylori to clarithromycin, metronidazole, and levofloxacin in children were 20.6%, 68.8%, and 9.0%, respectively, and the H. pylori resistance rate increased significantly from 2012 to 2014. 8 Generally, H. pylori acquires antibiotic resistance by chromosomal mutations, not by acquiring plasmids. 9 Although drug efflux proteins can contribute to the natural insensitivity to antibiotics and emerging antibiotic resistance, the main mechanism that contributes to H. pylori resistance is vertically transmitted point mutations in the DNA.…”

Section: Introductionmentioning

confidence: 99%

Mutations in the Antibiotic Target Genes Related to Clarithromycin, Metronidazole and Levofloxacin Resistance in Helicobacter pylori Strains from Children in China

Zhang

Wen

Xiao

et al. 2020

IDR

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Purpose: This study aimed to characterize common mutations of antibiotic-resistant gene of clarithromycin, metronidazole and levofloxacin in Helicobacter pylori (H. pylori) and determine their association with antibiotic resistance of H. pylori for providing a strategy for eradication therapy of H. pylori infection in children. Patients and Methods: The antibiotic resistance to clarithromycin, metronidazole and levofloxacin for H. pylori strains isolated from children was determined by E-test. The mutation of domain V of 23S rRNA, rdxA and frxA genes, gyrA and gyrB genes was performed by PCR-based sequencing of DNA fragments. Results: Out of the 79 H. pylori strains examined, 66 (83.5%) were resistant to at least one of the tested antibiotics and 13 (16.5%) were fully sensitive. A total of 29 (36.7%) strains were resistant to clarithromycin. Analysis of the 23S rRNA gene showed that most mutations occurred at the A2143G and T2182C sites, showing a frequency of 82.8% (24/29) and 89.7% (26/29) respectively. In the 11 sensitive strains to clarithromycin, the frequency of A2143G mutation was only 45.5%, which was significantly lower than that in resistant strains (P<0.05). There were 54 strains (68.4%) resistant to metronidazole, with most mutations occurring at G47A and T184G in the rdxA gene. T184G mutation was recognized in metronidazole-sensitive strains, but no G47A mutation was identified. Twelve strains (15.2%) were resistant to levofloxacin. Position 91 mutation of the gyrA gene occurred only in resistant strains, whereas position 87 mutations were detected in both sensitive and resistant strains to levofloxacin. Conclusion: In H. pylori resistant strains isolated from children in China, most mutations occurred at A2143G of the 23S rRNA gene for clarithromycin; G47A mutation of rdxA gene for metronidazole; and at 91 mutation of gyrA gene for levofloxacin. It is suggested that susceptibility testing together with screening the mutation of antimicrobial-resistant gene prior to treatment is important for the eradication of H. pylori in children.

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“…This contains one proton pump inhibitor (PPI) plus two antibiotics from different classes such as amoxicillin, metronidazole, clarithromycin, fluoroquinolones, tetracycline, and rifamycins for up to 14 days. These antibiotics might lose their eradication ability due to newly emerged antibiotic resistance of H. pylori [4][5][6] . When triple therapy failed to achieve its therapeutic goals practitioners may use quadruple, sequential and concomitant therapy, which showed better results even when they have been faced by resistance in various parts of the world 7 .…”

Section: Introductionmentioning

confidence: 99%

“…The deficiency in information regarding antibiotic susceptibility and H. pylori resistance in children is considered a major obstacle for H. pylori eradication. Additionally, the majority of the eradication studies had methodological issues such as recruiting small sample size 8 or butting their effort on adult patients 6 . This review aims at gathering comprehensive information regarding primary antibiotic resistance of H. pylori in children, to increase the awareness about the H. pylori resistance in children .…”

Section: Introductionmentioning

confidence: 99%

The Prevalence Rate of Antibiotic Resistance of Helicobacter Pylori Among Children: A Systematic Review

Ashi

Alzahrani

Alghamdi

et al. 2019

Int J Life Sci Pharm Res

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The lack of information regarding antibiotic susceptibility and H. pylori resistance in children is considered a major obstacle for H. pylori eradication. This review is aimed at collecting a comprehensive information about antibiotic resistance of H. pylori in children, to increase awareness about this population group. An electronic MEDLINE search was conducted using keywords with filter of "human studies". The studies were screened for eligibility criteria such as studied population of children, the use of three or more antibiotics treatment, and the reporting antibiotic primary resistance for H. pylori as the outcomes of the study. The full texts of the eligible articles were retrieved and the secondary exclusion was done based on the full text reading by two independent evaluators from 2000-2018. The electronic search of the literature resulted in 98 studies. After exclusion of irrelevant, duplicated and review studies, 11 studies which met the inclusion criteria were selected. Included studies aimed to determine, from the best available evidence, the prevalence of antibiotics resistance towards H. pylori pathogen. The resistance rate of H. pylori to metronidazole ranged from 75.20% to 10.1%, while resistant rate for clarithromycin ranged from 84.9% to 11.9%, resistance rate for rifampicin ranged from 13.3% to 0.9%, for furazolidone it was 0.06%, and resistance rate for amoxicillin was 0.5%-3.9%. The highest resistance rate of H. pylori in children was reported for azithromycin followed by clarithromycin and metronidazole, while it was low for moxifloxacin, rifampicin, furazolidone, and very low for amoxicillin.

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Antibiotics resistance of Helicobacter pylori in children with upper gastrointestinal symptoms in Hangzhou, China

Abstract: Antibiotic resistance was indicated in H. pylori strains isolated from children in Hangzhou, and it increased significantly during the 3 years. Our data strongly support current guidelines, which recommend antibiotic susceptibility tests prior to eradication therapy.

Cited by 22 publications

References 14 publications

Outcomes of furazolidone- and amoxicillin-based quadruple therapy forHelicobacter pyloriinfection and predictors of failed eradication

Outcomes of furazolidone- and amoxicillin-based quadruple therapy forHelicobacter pyloriinfection and predictors of failed eradication

<p>Mutations in the Antibiotic Target Genes Related to Clarithromycin, Metronidazole and Levofloxacin Resistance in <em>Helicobacter pylori</em> Strains from Children in China</p>

The Prevalence Rate of Antibiotic Resistance of Helicobacter Pylori Among Children: A Systematic Review

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