Oral Antibiotic Treatment of Helicobacter pylori Leads to Persistently Reduced Intestinal Colonization Rates with Oxalobacter formigenes

Abstract

Background and Purpose: Oxalobacter formigenes (OF) may play a protective role in preventing calcium oxalate stones. This is the first prospective study to evaluate the effect of antibiotics on OF colonization. Intestinal colonization by OF is associated with reduced urinary oxalate excretion. Exposure to antibiotics may be an important factor determining rates of colonization. Materials and Methods: The effect of antibiotics on OF colonization was compared in two groups: A group receiving antibiotics for gastric infection with Helicobacter pylori (HP) and a group without HP whose members were not receiving antibiotics. OF colonization in stool was detected by oxalate degradation at baseline and after 1 and 6 months. Results: The prevalence at baseline of intestinal colonization with OF was 43.1% among all patients screened. Among the 12 patients who were positive for OF who did not receive antibiotics, 11 (92%) had OF on stool tests at 1 month and 6 months. Of the 19 participants who were positive for OF and who received antibiotics for HP, only 7 (36.8%) continued to be colonized by OF on follow-up stool testing at 1 and 6 months (P = 0.003 by Fisher exact test). Amoxicillin and clarithromycin caused 62.5% of subjects to become negative for OF at 1 month; 56.2% remained negative for OF at 6 months. Conclusions: Antibiotics for HP infection effectively reduced colonization with OF, an effect present at 1 and 6 months after treatment. The lasting elimination of OF could be associated with hyperoxaluria and be a factor in recurrent kidney stone disease.

The role of the microbiome in kidney stone formation

“…The effect of antibiotics on Oxf colonization was evaluated in patients receiving oral antibiotic treatment for Helicobacter pylori ( HP ) [23]. Oxf strains are susceptible to multiple antibiotics including quinolones, macrolides, tetracyclines and metronidazole.…”

Oxalobacter formigenes Colonization and Oxalate Dynamics in a Mouse Model

“…Studies to date suggest it occurs early in childhood (11), and if animal experiments provide any insight, it is obtained from the environment, not directly from the mother (12). Several studies have indicated that the intake of antibiotics can result in the loss of colonization (7,(13)(14)(15), and this is supported by decreased prevalence rates of O. formigenes in both cystic fibrosis patients (16) and calcium oxalate stone formers who are frequently prescribed antibiotics (15,17).Oxalate-degrading microbes are present in wild rodents (6,18,19) but are few or absent in laboratory rats (18,20) and laboratory mice (21). It is postulated that procedures used for establishment and maintenance of commercial rodent colonies limit the introduction and establishment of anaerobic specialist oxalate-degrading organisms.…”

“…Studies to date suggest it occurs early in childhood (11), and if animal experiments provide any insight, it is obtained from the environment, not directly from the mother (12). Several studies have indicated that the intake of antibiotics can result in the loss of colonization (7,(13)(14)(15), and this is supported by decreased prevalence rates of O. formigenes in both cystic fibrosis patients (16) and calcium oxalate stone formers who are frequently prescribed antibiotics (15,17).…”

Bariatric Surgery and Urinary Stone Disease

“…Endojen okzalat yıkımında rol oynayan Oxalobacter formigenes tek enerji kaynağı olarak okzalat kullanan zorunlu anaerop Gram-negatif bir bakteridir [30,31]. Jejunoileal by-pass ve antibiyotik kullanımı gibi Oxalobacter formigenes kolonizasyonunda kayba yol açan durumlar idrar okzalat düzeyini arttırabilirler [29,31,32]. Hiperokzalürili hastalarda oral Oxalobacter formigenes kullanımı yeni bir tedavi stratejisi olarak karşımıza çıkmaktadır [30,32].…”

“…Jejunoileal by-pass ve antibiyotik kullanımı gibi Oxalobacter formigenes kolonizasyonunda kayba yol açan durumlar idrar okzalat düzeyini arttırabilirler [29,31,32]. Hiperokzalürili hastalarda oral Oxalobacter formigenes kullanımı yeni bir tedavi stratejisi olarak karşımıza çıkmaktadır [30,32]. Primer hiperokzalürili küçük bir hasta grubunda oral Oxalobacter formigenes verilerek yapılan güncel bir çalışmada hem plazma hem de idrar okzalat konsantrasyonlarının düştüğünün gösterilmesi bu tedavi stratejisinin potansiyel yararını desteklemektedir [33].…”