Letter: third‐line rescue therapy with levofloxacin after failure of two treatments to eradicate <i>Helicobacter pylori</i> infection – author's reply

Goh, Khean Lee

doi:10.1111/j.1365-2036.2012.05120.x

Cited by 4 publications

(4 citation statements)

References 6 publications

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“…Levofloxacin has also been increasingly used in clinical practice in Malaysia. We have reported its use as an effective rescue therapy previously (Goh, Manikam & Qua, 2012). Although previously reported to be low, levofloxacin resistance has also increased compared to previous reports, in the present study and this is also alarming to us.…”

Section: Discussionsupporting

confidence: 54%

“…Unrestricted use of clarithromycin against H. pylori attributes to suboptimal results and antibiotic resistance. In Malaysia, a low resistance rate for clarithromycin (less than 6.8%) has been reported, therefore clarithromycin (500 mg) is continued to be used as our treatment regimens together with amoxicillin (1 g) and pantoprazole 40 mg (Qua, Manikam & Goh, 2010) or rabeprazole (20 mg) (Goh, Manikam & Qua, 2012;Leow et al, 2018). However, unsatisfactory efficacy was seen with an overall eradication rate of only 71.2% in a comparative, randomized and open-labeled study (Leow et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

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Current status ofHelicobacter pyloriresistance to Clarithromycin and Levofloxacin in Malaysia—findings from a molecular based study

Puah

Goh

et al. 2021

PeerJ

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Background Resistance to clarithromycin and levofloxacin in Helicobacter pylori which resulted in treatment failures has become a major challenge for physicians worldwide. The resistance is mainly mediated by mutations in a specific domain of the 23S rRNA, gyrA and gyrB genes for clarithromycin and levofloxacin respectively. Hence in this study, we aimed to investigate the current status of H. pylori resistance in our hospital to these two antibiotics based on the molecular approach. Materials and Methods Gastric biopsy samples were obtained from treatment-naïve patients. Bacterial genomic DNA was extracted using a commercial kit and continued with DNA amplification using polymerase chain reaction (PCR) with specific primers. The PCR amplicons were subjected to sequencing on 23S rRNA gene targeting nucleotide positions at 2,146, 2,147, 2,186 and amino acids at gyrA positions 87 and 91 and gyrB positions 436, 438, 481, 484 to investigate the possible mutations or polymorphisms of genes that lead to clarithromycin and levofloxacin resistance respectively. Results Sixty-one urease-positive gastric biopsy samples were studied. The findings revealed the primary resistance rates to clarithromycin was 14.8% and to levofloxacin was 3.3% in our current scenario based on detection of reported resistance-related mutations of A2147G and D91N in 23S rRNA and gyrA genes, respectively. Interestingly, we found a high rate of silent mutations of the gyrA codon 87Asn (32.8%, 20/61) and two polymorphisms of the gyrB D481E (16.4%, 10/61) and R484K (21.3%, 13/61). The role of these polymorphisms in gyrB remained to be elucidated whether the levels of levofloxacin resistance are related to the position/amino acid. Conclusion The primary resistance rate of H. pylori to clarithromycin has increased compared to the previous report in Malaysia. Therefore, molecular screening could aid and is important for the selection of antibiotics for H. pylori eradication therapies.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Current status ofHelicobacter pyloriresistance to Clarithromycin and Levofloxacin in Malaysia—findings from a molecular based study

Puah

Goh

et al. 2021

PeerJ

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“…In the local population, fluoroquinolone appears to be superior in secondary or tertiary rescue regimens and proven to show high eradication rate [23] , [24] . In contrast to previous reporting of zero resistance to levofloxacin in Malaysia [26] , we found a low but significant increase of fluoroquinolone resistance, which is of concern too.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the high metronidazole resistance rate in Malaysia [21] , [22] , metronidazole is not recommended. In cases where the therapy failed, two consecutive rescue regimens are used [23] , [24] . The first line rescue regimen consists of rabeprazole 20 mg three times daily and amoxicillin 1 g three times daily for two weeks [23] .…”

Section: Introductionmentioning

confidence: 99%

Functional and Molecular Surveillance of Helicobacter pylori Antibiotic Resistance in Kuala Lumpur

et al. 2014

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Background Helicobacter pylori is the etiological agent for diseases ranging from chronic gastritis and peptic ulcer disease to gastric adenocarcinoma and primary gastric B-cell lymphoma. Emergence of resistance to antibiotics possesses a challenge to the effort to eradicate H. pylori using conventional antibiotic-based therapies. The molecular mechanisms that contribute to the resistance of these strains have yet to be identified and are important for understanding the evolutional pattern and selective pressure imposed by the environment.Methods and Findings H. pylori was isolated from 102 patients diagnosed with gastrointestinal diseases, who underwent endoscopy at University Malaya Medical Centre (UMMC). The isolates were tested for their susceptibility on eleven antibiotics using Etest. Based on susceptibility test, 32.3% of the isolates were found to have primary metronidazole resistance; followed by clarithromycin (6.8%) and fluoroquinolones (6.8%). To further investigate the resistant strains, mutational patterns of gene rdxA, frxA, gyrA, gyrB, and 23S rRNA were studied. Consistent with the previous reports, metronidazole resistance was prevalent in the local population. However, clarithromycin, fluoroquinolone and multi-drug resistance were shown to be emerging. Molecular patterns correlated well with phenotypic data. Interestingly, multi-drug resistant (MDR) strains were found to be associated with higher minimum inhibitory concentration (MIC) than their single-drug resistant (SDR) counterparts. Most importantly, clarithromycin-resistant strains were suggested to have a higher incidence for developing multi-drug resistance.ConclusionData from this study highlighted the urgency to monitor closely the prevalence of antibiotic resistance in the Malaysian population; especially that of clarithromycin and multi-drug resistance. Further study is needed to understand the molecular association between clarithromycin resistance and multi-drug resistance in H. pylori. The report serves a reminder that a strict antibiotic usage policy is needed in Malaysia and other developing countries (especially those where H. pylori prevalence remained high).

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Helicobacter pylori Antimicrobial Susceptibility Testing-Guided Salvage Therapy in the USA: A Real Life Experience

et al. 2017

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Letter: third‐line rescue therapy with levofloxacin after failure of two treatments to eradicate Helicobacter pylori infection – author's reply

Cited by 4 publications

References 6 publications

Current status ofHelicobacter pyloriresistance to Clarithromycin and Levofloxacin in Malaysia—findings from a molecular based study

Current status ofHelicobacter pyloriresistance to Clarithromycin and Levofloxacin in Malaysia—findings from a molecular based study

Functional and Molecular Surveillance of Helicobacter pylori Antibiotic Resistance in Kuala Lumpur

Helicobacter pylori Antimicrobial Susceptibility Testing-Guided Salvage Therapy in the USA: A Real Life Experience

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