Multicenter Study of Antibiotic Resistance Profile of<i>H. pylori</i>and Distribution of CYP2C19 Gene Polymorphism in Rural Population of Chongqing, China

Han, Ran; Lü, Hong; Jiang, Ming-Wan; Tan, K K; Peng, Zhong; Hu, Jiali; Fang, Dian‐Chun; Lan, Chun‐Hui; Wu, Xiaoling

doi:10.1155/2016/8547686

Cited by 19 publications

(25 citation statements)

References 24 publications

(23 reference statements)

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“…This study showed that distribution of CYP2C19 gene polymorphism in population from both Beijing in northern China and Zhejiang province in south eastern China was consistent with that of Chongqing in southwestern China [ 24 ] and Asia [ 7 ]. PMs and EMs accounted for a significant proportion in Asian population, while EMs accounted for one in Europeans [ 25 ].…”

Section: Discussionsupporting

confidence: 53%

“…CYP2C19 polymorphism could influence the PPIs metabolization and H + concentration in stomach and thus affect activity and stability of antibiotics. H. pylori was not completely destroyed or inhibited to grow by these antibiotics in the microenvironment, which might lead to microevolution of H. pylori even development of drug resistant strains [ 24 ]. Our study indicated that CYP2C19 genetic polymorphism was not significant associated with susceptibility of clarithromycin ( P = 0.079) or levofloxacin ( P =0.17); however there was a trend of correlation between CYP2C19 genotypes and clarithromycin resistance.…”

Section: Discussionmentioning

confidence: 99%

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Microarray-Based Detection and Clinical Evaluation for Helicobacter pylori Resistance to Clarithromycin or Levofloxacin and the Genotype of CYP2C19 in 1083 Patients

Song

Dou

Zhou

et al. 2018

BioMed Research International

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Background. Helicobacter pylori (H. pylori) is one of the most frequent and persistent bacterial infections that affect nearly half of the world's population. Antibiotic resistance is a constantly evolving process and local surveillance of antibiotic resistance is warranted to guide clinicians in their choice of therapy. The aim of this study was to establish a microarray-based detection to identify H. pylori infection, clarithromycin and levofloxacin susceptibility, and CYP2C19 genetic polymorphism and guide to potential choice of proton pump inhibitor (PPI), antibiotic administration for tailored H. pylori eradication therapy. Methods. By analyzing the sequence of human genomic CYP2C19⁎2 and CYP2C19⁎3 and mutations within the 23S rRNA and gyrA gene regions conferring clarithromycin and levofloxacin resistance, respectively, we developed a microarray for individual therapy detection of H. pylori infection. Plasmids were established as positive or limit of detection (LOD) reference materials. The specificity and sensitivity of the microarray had been performed. And a total of 1083 gastric biopsy samples were tested and the Kappa value had been calculated between the array and Sanger sequencing. We also analyzed the resistance to clarithromycin and levofloxacin in China, as well as the CYP2C19 polymorphisms. Results. The LOD of detecting H. pylori was 103 CFU/mL and human genome DNA was 2 ng/μL. The detection results of 1083 gastric biopsy samples showed that 691 (63.80%) were H. pylori positive, of which 266 (38.49%) were resistant to clarithromycin, 192 (27.79%) were resistant to levofloxacin, and 61 (8.83%) were resistant to both of them. For the type of CYP2C19 polymorphism, 412 (38.04%) were homozygous fast type (HomEM), 574 (53%) were heterozygous EM (HetEM), and 97 (8.96%) were poor metabolizer (PM). Conclusions. The proposed microarray-based detection has high specificity, sensitivity, and reproducibility for detecting the resistance of clarithromycin or levofloxacin as well as CYP2C19 polymorphism, which may help to improve the clinical eradication rate of H. pylori.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Microarray-Based Detection and Clinical Evaluation for Helicobacter pylori Resistance to Clarithromycin or Levofloxacin and the Genotype of CYP2C19 in 1083 Patients

Song

Dou

Zhou

et al. 2018

BioMed Research International

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“…The prevalence of amoxicillin resistance was 0–3.6% and 0% in Taiwan and Chongqing, respectively. In these two studies,[ 22 28 ] there were no differences in CYP2C19 gene polymorphism and the prevalence of amoxicillin resistance among the subjects.…”

Section: Discussionmentioning

confidence: 99%

“…[ 22 ] In the report by Yang et al .,[ 22 ] patients with extensive, intermediate, or poor metabolizers of the CYP2C19 gene accounted for 43.6, 43.6, and 12.8%, respectively, of the study population. In our previous studies from Chongqing, China,[ 22 28 ] these accounted for 44.4, 45.8, and 9.8% of the patients. The prevalence of amoxicillin resistance was 0–3.6% and 0% in Taiwan and Chongqing, respectively.…”

Section: Discussionmentioning

confidence: 99%

Optimized high-dose amoxicillin–proton-pump inhibitor dual therapies fail to achieve high cure rates in China

Yang

Zhou

et al. 2017

Saudi J Gastroenterol

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Background\Aim:Quadruple daily administration of proton-pump inhibitor (PPI) therapy achieves potent acid inhibition, and combined with amoxicillin, with its pharmacodynamic and pharmacokinetic characteristics, may be efficient for Helicobacter pylori eradication. We compared the efficacy of two optimized high-dose dual therapies with a bismuth-containing quadruple regimen for treating H. pylori infection. Rabeprazole dosages for H. pylori eradication were also evaluated.Patients and Methods:Treatment-naive and H. pylori-positive subjects were recruited and randomly apportioned to three treatment groups: Group A (n = 87), rabeprazole 10 mg plus amoxicillin 750 mg (4 times/day for 14 days); Group B (n = 87), rabeprazole 20 mg plus amoxicillin 750 mg (4 times/day for 14 days); and Group C (n = 89), bismuth-containing quadruple regimen consisting of rabeprazole 20 mg, bismuth 220 mg, amoxicillin 1000 mg, and clarithromycin 500 mg (2 times/day for 14 days). Four weeks after treatment discontinuation, patients were examined for H. pylori infection by 13C-urea breath test. The rates of adverse effects, compliance, and eradication were evaluated.Results:Eradication rates in groups A, B, and C were 78.1, 81.6, and 84.3%, respectively, based on intention-to-treat analysis, or 79.1, 83.5, and 86.2%, according to per-protocol analysis. Rates of adverse events and compliance of the three groups were similar.Conclusion:For treating H. pylori infection, optimized high-dose amoxicillin–PPI dual therapies failed to achieve high cure rates in China and held no advantage over a bismuth-containing quadruple regimen.

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“…A significant and welcome increase was noted over the last year in the number of studies addressing the important topic of antimicrobial resistance in H. pylori infection. These are summarized in Table . A key message emerging is the relentless rise in antibiotic resistance, especially to clarithromycin and levofloxacin.…”

Section: Antimicrobial Resistancementioning

confidence: 99%

Treatment of Helicobacter pylori infection 2017

et al. 2017

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Over the last decade, it has been widely reported that the success of Helicobacter pylori eradication treatment is falling. A steady decline was observed in the number of patients achieving eradication with standard first-line triple therapy of two antibiotics and a proton pump inhibitor [1][2][3]. It now appears that the first-line eradication therapies most commonly used in everyday clinical practice fall considerably short of the 80% intention-to-treat (ITT) eradication rates that are considered the minimal acceptable levels as recommended in the Maastricht guidelines [4]. Interestingly, two studies emerged from Asian centers in the last 12 months, which show that, in this part of the world at least, eradication levels using standard therapies remain close to 80%. A Malaysian study showed a standard 1-week pantoprazole, amoxycillin, and clarithromycin regimen to be well tolerated and highly efficacious with a per-protocol eradication rate of 84% [5]. A Japanese study showed remarkably consistent per-protocol eradication rates from 2001 to 2009 fluctuating between 75 and 78% for standard 7-day triple-therapy regimens [6]. A limit of many studies especially those including clarithromycin or levofloxacin is that H. pylori susceptibility to the drugs, which is the main prediction of failure, was not tested. LevofloxacinThe use of levofloxacin as a first-line therapy has been examined in great depth in the last year. Levofloxacin may be used as a substitute for clarithromycin in either a standard triple or sequential regimen. A large study comparing the antibiotics in either regimen shows a clear advantage to levofloxacin in both combinations. Per-protocol cure rates for triple therapy were 66% for omeprazole-clarithromycin-amoxycillin compared with 83% for omeprazole-levofloxacin-amoxycillin and 81% for omeprazole-amoxycillin-clarithromycin-metronidazole vs 85% for omeprazole-amoxycillin-levofloxacinmetronidazole, with no difference in compliance rates or adverse events [7]. It has been proposed that sequential levofloxacin-based regimens are of most benefit in areas where clarithromycin resistance is in excess of 15%, and another study in such an area showed eradication rates of 81% with clarithromycin sequential therapy compared with 96% with levofloxacin sequential therapy. A third arm in this study looked at the dose of levofloxacin required and illustrated no benefit in increasing the dose from 250 to 500 mg [8]. Indeed, another study went so far as to suggest that once-daily dosing of a levofloxacin-based triple regimen may be as efficacious as twice daily [9]. The literature from Asia also seems to support levofloxacin as a good alternative first-line therapy. A study on a triple regimen showed per-protocol eradication rates of 78% for standard clarithromycin-containing therapies compared with 83% for a levofloxacin-based regimen [10]. Another study from the Middle East looked at whether combining clarithromycin and levofloxacin in the same regimen could be Keywords Peptic ulcer disease, resistance, compli...

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Multicenter Study of Antibiotic Resistance Profile ofH. pyloriand Distribution of CYP2C19 Gene Polymorphism in Rural Population of Chongqing, China

Cited by 19 publications

References 24 publications

Microarray-Based Detection and Clinical Evaluation for Helicobacter pylori Resistance to Clarithromycin or Levofloxacin and the Genotype of CYP2C19 in 1083 Patients

Microarray-Based Detection and Clinical Evaluation for Helicobacter pylori Resistance to Clarithromycin or Levofloxacin and the Genotype of CYP2C19 in 1083 Patients

Optimized high-dose amoxicillin–proton-pump inhibitor dual therapies fail to achieve high cure rates in China

Treatment of Helicobacter pylori infection 2017

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