Antimicrobial Resistance Incidence and Risk Factors among<i>Helicobacter pylori</i>–Infected Persons, United States

Duck, William M.; Sobel, Jeremy; Pruckler, Janet M.; Song, Qunsheng; Swerdlow, David L.; Friedman, Cindy R.; Sulka, Alana; Swaminathan, B.; Taylor, Tom; Hoekstra, Robert M.; Griffin, Patricia M.; Smoot, Duane T.; Peek, Rick; Metz, David C.; Bloom, Peter B.; Goldschmid, Steven; Parsonnet, Julie; Triadafilopoulos, George; Perez-Perez, Guillermo I.; Vakil, Nimish; Ernst, Peter B.; Czinn, Steve; Dunne, Donald; Gold, Ben

doi:10.3201/eid1006.030744

Cited by 192 publications

(159 citation statements)

References 22 publications

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“…Immunohistochemistry offers a suitable method for The presence of mutations associated with clarithromycin resistance by melt curve analysis is also shown. 21 In total, nearly half of the patients in our study (50%) were positive for mutations associated with clarithromycin resistance. Although this high percentage is striking in comparison with the HARP study, it is important to note that patients in our study population typically present for biopsy following presumed failure of initial therapy.…”

Section: Discussionmentioning

confidence: 72%

PCR detection of clarithromycin-susceptible and -resistant Helicobacter pylori from formalin-fixed, paraffin-embedded gastric biopsies

et al. 2013

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Antimicrobial resistance to clarithromycin is a growing concern in the treatment of Helicobacter pylori and is associated with three major point mutations of the 23S rRNA, A2142C, A2142G, and A2143G. The use of traditional culture-based methods for determination of clarithromycin resistance in H. pylori are time consuming and lack sensitivity. We implemented a real-time PCR with melt curve analysis to detect and characterize H. pylori in formalin-fixed, paraffin-embedded gastric biopsy specimens to assess the frequency of clarithromycin resistance mutations in our study population. One hundred and fifty-three formalin-fixed, paraffin-embedded gastric biopsies were chosen on the basis of positive immunohistochemical staining for H. pylori and an accompanying histopathological diagnosis of Helicobacter-associated gastritis. New adjacent sections were taken for immunohistochemical staining and DNA extraction with subsequent testing by PCR assay and melt curve analysis using a primer and probe combination first described by Oleastro et al. 12 One hundred and forty-six samples demonstrated adequate amplification of a human DNA control target. Of these, there were 122 H. pylori immunohistochemistry-positive samples. In all, 103 out of 122 (84%) immunohistochemistry-positive samples demonstrated amplifiable H. pylori 23S rRNA gene target and 19 (16%) demonstrated no amplification of H. pylori. Twenty-two samples were negative for H. pylori by immunohistochemistry and PCR. Two were negative for H. pylori by immunohistochemistry, but were positive for H. pylori by PCR. In all, 52 out of 105 (50%) PCR-positive samples demonstrated resistance mutations, and it was determined that a heterogeneous population of mutated and unmutated organisms was present in 11 out of 52 samples. The use of PCR assays allows for a timely assessment of clarithromycin resistance status without the disadvantages of culture-based methods, and may lead to a decrease in treatment failure rates.

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Section: Discussionmentioning

confidence: 72%

PCR detection of clarithromycin-susceptible and -resistant Helicobacter pylori from formalin-fixed, paraffin-embedded gastric biopsies

et al. 2013

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“…Another study showed that 80% of strains in Mexico were resistant to metronidazole [55] . Overall, metronidazole resistance is > 50% in much of the world but there are reports that metronidazole resistance has declined in Northern Europe [9,30] , while in the United States and Europe, the metronidazole resistance rate was reported to be < 40% [30,56] , and 22.5% in 102 isolates from Norway [57] . However, in Central and Southern Europe, resistance rates remain markedly higher-34.9% in France and 32.7% in Germany [47,58] .…”

Section: Current Antibiotic Resistance In Worldwidementioning

confidence: 99%

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Kim

Choi

Chung

2015

WJGPT

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Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori ) has been associated with gastroduodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Core tip: This article reviews the recent literature describing antibiotic resistance and trends in Helicobacter pylori (H. pylori ) treatment. As there is no effective conventional therapy, new treatments are being developed and bismuth quadruple, sequential, concomitant therapies are recommended as a first-line regimen in regions with high levels of clarithromycin resistance. Quinolones have also been used for H. pylori treatment, although the cure rate has gradually reduced with this approach. New therapeutic directions include probiotic supplementation, tailored therapy, novel agents, and nanotechnology.

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“…However, concerns have been expressed regarding the progressive reduction of its efficiency over the past years [6], possibly due to the development of antimicrobial resistance, particularly in the United States and Europe [7,8]. Resistance is variable from country to country, and also within different regions of the same country [9,10].…”

Section: Introductionmentioning

confidence: 99%

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

Felga

Silva

Navarro–Rodriguez

et al. 2010

J Infect Dev Ctries

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Introduction: The scheme proton pump inhibitor/amoxicillin/clarithromycin (PPI/AC) is still the first-line treatment for Helicobacter pylori (H. pylori) infections despite evidence suggesting its failure in up to 20% to 30% of patients. Methodology: This study involved 493 patients who were prescribed omeprazole (20 mg twice a day) or another proton pump inhibitor in equivalent dosage, amoxicillin (1 g twice a day), and clarithromycin (500 mg twice a day) for seven days. Efficacy was determined by negative urease test and absence of H. pylori on gastric biopsy samples twelve weeks after the end of treatment. Safety was defined according to the adverse effects reported. Mean age of the patients was (± SD) 48.96 ± 13, and demographic and clinical data were recorded for correlation with treatment outcomes. Results: Out of 493 patients, 316 (64.1%) presented duodenal ulcer, 111 (22.5%) gastric ulcer, and 66 (14.4%) simultaneous gastric and duodenal ulcers. Additionally, 267 (54.2%) patients had at least one risk factor for peptic ulcer disease, smoking being the most common (99 [36.5%]). Successful eradication was achieved in 408 patients. The eradication rates per protocol, and according to the intention to treat, were 88.8% and 82.7%, respectively. Of 164 (35.5%) patients who presented adverse effects, 100 (61%) reported them as mild and only six (3.7%) patients had to discontinue treatment. Previous use of tobacco and non-steroid anti-inflammatory drugs was the only risk factor for treatment failure (P 0.00). Conclusion: PPI/AC is still a valuable and remarkably tolerable option for first-line H. pylori eradication in Brazil.

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Antimicrobial Resistance Incidence and Risk Factors amongHelicobacter pylori–Infected Persons, United States

Cited by 192 publications

References 22 publications

PCR detection of clarithromycin-susceptible and -resistant Helicobacter pylori from formalin-fixed, paraffin-embedded gastric biopsies

PCR detection of clarithromycin-susceptible and -resistant Helicobacter pylori from formalin-fixed, paraffin-embedded gastric biopsies

Antibiotic treatment forHelicobacter pylori: Is the end coming?

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

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