Antimicrobial susceptibility testing before first-line treatment for Helicobacter pylori infection in patients with dual or triple antibiotic resistance

Abstract

AIMTo evaluate the efficacy of antimicrobial susceptibility-guided therapy before first-line treatment for infection in patients with dual or triple antibiotic resistance.METHODSA total of 1034 patients infected by Helicobacter pylori (H. pylori) during 2013-2014 were tested for antimicrobial susceptibility. 157 of 1034 (15%) patients showed resistance to two (127/1034; 12%) and to three (30/1034; 3%) antibiotics. Sixty-eight patients with dual H. pylori-resistance (clarithromycin, metronidazole or levofloxacin) were treated for 10 d with triple therapies: OAL (omeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d., and levofloxacin 500 mg b.i.d.) 43 cases, OAM (omeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d., and metronidazole 500 mg b.i.d.) 12 cases and OAC (omeprazole 20 mg b.id., amoxicillin 1 g b.i.d., and clarithromycin 500 mg b.i.d.) 13 cases based on the antimicrobial susceptibility testing. Twelve patients showed triple H. pylori-resistance (clarithromycin, metronidazole and levofloxacin) and received for 10 d triple therapy with OAR (omeprazole 20 mg b.id., amoxicillin 1 g b.i.d., and rifabutin 150 mg b.i.d.). Eradication was confirmed by 13C-urea breath test. Adverse effects and compliance were assessed by a questionnaire.RESULTSIntention-to-treat eradication rates were: OAL (97.6%), OAM (91.6%), OAC (92.3%) and OAR (58.3%). Cure rate was significantly higher in naïve patients treated with OAR-10 compared to patients who had two or three previous treatment failures (83% vs 33%). Adverse events rates for OAL, OAM, OAC and OAR were 22%, 25%, 23% and 17%, respectively, all of them mild-moderate.CONCLUSIONAntimicrobial susceptibility-guided triple therapies during 10 d for first-line treatment leads to an eradication rate superior to 90% in patients with dual antibiotic H. pylori resistance.

Treatment of Helicobacter pylori infection in 2018

“…There was no significant difference in eradication rates between treatment‐naive and treatment‐experienced groups . This, however, is at odds with a Spanish study which found significantly higher eradication rates (83% vs 33%) in culture‐guided therapy in treatment‐naïve patients …”

“…61 This, however, is at odds with a Spanish study which found significantly higher eradication rates (83% vs 33%) in culture-guided therapy in treatment-naïve patients. 10 An Italian study comparing sequential and bismuth-based therapy did not find that the pattern of bacterial resistance significantly affected eradication rates. Dual resistance to clarithromycin and amoxicillin did, however, lower eradication rates in both treatment strategies.…”

“…Indeed, third‐line culture‐guided eradication therapy often fails. Multidrug (>3) resistance rates have been found in 15%‐31% of patients undergoing third‐line therapy . Age >50 years was the only discerning factor associated with resistance to three or more antibiotics, most likely related to lifetime exposure .…”

“…Quadruple therapy is gaining in popularity particularly in areas with increasing resistance to standard triple therapy . Tailored, culture‐based treatment seems a logical choice and has significant success . However, there is an expense and delay involved, which limits its universal use at present.…”

Helicobacter pylori antimicrobial resistance during a 5‐year period (2013‐2017) in northern Spain and its relationship with the eradication therapies

“…In the Microbiology Department of HUD (San Sebastian), cultures are carried out “as routine practice” since 1994 . During the period 2000‐2012, resistance to two or three antimicrobials was around 12.5% for dual resistance and 2.9% for triple resistance …”