Clarithromycin for first-line treatment of Helicobacter pylori infection after culture in high-resistance regions

Martos, Maider; Bujanda, Luís; Salicio, Y.; Sarasqueta, Cristina; Ibarra, Begoña; Mendarte, Usua; Fernández‐Reyes, María José; Cosme, Ángel

doi:10.1097/meg.0000000000000197

Cited by 26 publications

(20 citation statements)

References 15 publications

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“…Primary and relapse isolates were included. E-test strips were placed on Brucella agar plates with 5% hemolized horse blood, supplemented with 1% Vitox and were incubated at 37 °C for 48-72 h under microaerophilic conditions with 80% humidity[3]. …”

Section: Methodsmentioning

confidence: 99%

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

Cosme

Montes

Ibarra

et al. 2017

WJG

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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.

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Section: Methodsmentioning

confidence: 99%

“…Primary end point: confirmed H. pylori eradication by intention-to-treat (ITT) in each group of at least 6 wk after treatment completion using the urea breath test (UBT) with 100 mg of urea, in accordance with a previously described protocol[3]. …”

Section: Methodsmentioning

confidence: 99%

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

Cosme

Montes

Ibarra

et al. 2017

WJG

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“…The success of the standard eradication therapy (first-line therapy) is thought to be lower than 85% if clarithromycin resistance is higher than 10%[81]. Several studies have confirmed that the eradication rate obtained with the standard therapy is 87%-92% in clarithromycin-susceptible H. pylori strains and decreases to 18%-21% in clarithromycin-resistant strains[82]. …”

Section: Contribution Of Antimicrobial Susceptibility Testing To the mentioning

confidence: 99%

“…The eradication rates of susceptibility-guided treatments are generally higher than those of empirical treatment regimens[7,81,86]. Recent studies have also shown that susceptibility-based treatment improves the efficacy of the therapy used after first- or second-line treatment failure as well as the efficacy of first-line therapy (Tables 1 and 2)[26,73,82-84,87-92]. A meta-analysis of five randomized controlled trials concluded that the culture-based pretreatment success rates were 16% higher than those of various standard triple therapies used as the first-line treatment for H. pylori infection in 701 patients (per protocol 93% vs 76%)[6,9,82].…”

Section: Contribution Of Antimicrobial Susceptibility Testing To the mentioning

confidence: 99%

“…Recent studies have also shown that susceptibility-based treatment improves the efficacy of the therapy used after first- or second-line treatment failure as well as the efficacy of first-line therapy (Tables 1 and 2)[26,73,82-84,87-92]. A meta-analysis of five randomized controlled trials concluded that the culture-based pretreatment success rates were 16% higher than those of various standard triple therapies used as the first-line treatment for H. pylori infection in 701 patients (per protocol 93% vs 76%)[6,9,82]. Another meta-analysis published by Chen et al[22] in 2016 included 13 controlled clinical trials comparing the eradication efficacies between tailored and empirical regimens and demonstrated that the efficacy of the first-line tailored therapy was higher than that of first-line empirical therapies.…”

Section: Contribution Of Antimicrobial Susceptibility Testing To the mentioning

confidence: 99%

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Importance of antimicrobial susceptibility testing for the management of eradication inHelicobacter pyloriinfection

Arslan

Yılmaz

Demiray-Gürbüz

2017

WJG

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The management of Helicobacter pylori (H. pylori) infection treatment differs from the common treatment protocol for other infectious diseases. Because culture- or molecular-guided approaches face several practical issues, such as the invasive procedures required to obtain gastric biopsy specimens and the lack of availability of routine laboratory testing in some places, H. pylori treatment includes the administration of two or three empirically selected antibiotics combined with a proton pump inhibitor rather than evidence-based eradication treatment. The efficacy of empirical therapy is decreasing, mostly due to increasing multiple resistance. Multiresistance to levofloxacin, clarithromycin, and metronidazole, which are commonly used in empirical treatments, appears to have increased in many countries. Mutations play a primary role in the antimicrobial resistance of H. pylori, but many different mechanisms can be involved in the development of antibiotic resistance. Determining and understanding these possible mechanisms might allow the development of new methods for the detection of H. pylori and the determination of antimicrobial resistance. A treatment based on the detection of antimicrobial resistance is usually more effective than empirical treatment. Nevertheless, such an approach before treatment is still not recommended in the Maastricht guidelines due to the difficulty associated with the routine application of available culture- or molecular-based susceptibility tests, which are usually administered in cases of treatment failure. The management of first and rescue treatments requires further research due to the steadily increase in antimicrobial resistance.

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Are probiotics useful for therapy of Helicobacter pylori diseases?

Eslami

Yousefi

Kokhaei

et al. 2019

Comparative Immunology, Microbiology and Infectious Diseases

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Clarithromycin for first-line treatment of Helicobacter pylori infection after culture in high-resistance regions

Abstract: The eradication rate was significantly higher with clarithromycin-based triple therapy for patients with clarithromycin-susceptible HP isolates compared with those for whom no information on the corresponding susceptibility was available (ClinicalTrials.gov number NCT01486082).

Cited by 26 publications

References 15 publications

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

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

Importance of antimicrobial susceptibility testing for the management of eradication inHelicobacter pyloriinfection

Are probiotics useful for therapy of Helicobacter pylori diseases?

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