Pretreatment antimicrobial susceptibility testing is cost saving in the eradication of Helicobacter pylori

Romano, Marco; Marmo, Riccardo; Cuomo, Antonio; Simone, Teresa De; Mucherino, C.; Iovene, Maria Rosaria; Montella, Fortunato; Tufano, Maria Antonietta; Blanco, C. Del Vecchio; Nardone, Gerardo

doi:10.1016/s1542-3565(03)00131-9

Cited by 83 publications

(76 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Pretreatment susceptibility testing was shown to be cost saving and associated with higher eradication rates (21); other data question the use of prior susceptibility testing before the use of first-and second-line therapies (16,18). These conflicting results are probably due to the different study settings and the different patients evaluated.…”

Section: Fig 2 Proportions Ofmentioning

confidence: 99%

Quinolone Resistance in Helicobacter pylori Isolates in Germany

Glocker

Stueger

Kist

2007

Antimicrob Agents Chemother

View full text Add to dashboard Cite

We show that quinolone resistance in Helicobacter pylori has reached an alarming level in Germany. Our data suggest that the use of quinolones requires prior antimicrobial susceptibility testing, especially for isolates from patients who have already undergone previous unsuccessful eradication treatments, and also underline the further need for surveillance studies to monitor antibiotic resistance in H. pylori.Helicobacter pylori infection causes gastritis and can result in complications such as peptic ulcer diseases, mucosa-associated lymphoid tissue lymphoma, or gastric cancer (22). In Germany, antibiotic chemotherapy that includes amoxicillin, clarithromycin, and a proton pump inhibitor is recommended for the eradication of these bacteria in infected individuals (14). After treatment failures, quinolone-based triple therapies have been shown to be highly effective and therefore have been proposed as rescue regimens (4,20).The aim of this study was to estimate the prevalence of quinolone resistance in H. pylori by testing the antimicrobial susceptibilities of clinical isolates obtained between 2001 and 2005. We analyzed H. pylori isolates from patients who had already been treated (n ϭ 805; 86%) or who had not been treated (n ϭ 126; 14%). Susceptibilities to ciprofloxacin, metronidazole, and clarithromycin were determined by the Etest method, according to the manufacturer's instructions and a modified protocol, as described previously (9). Isolates were classified as resistant to ciprofloxacin and clarithromycin when the MIC was Ͼ1 mg/liter and were classified as resistant to metronidazole when the MIC was Ͼ8 mg/liter (9, 12).Due to the predominance of previously treated patients, the overall rates of resistance to metronidazole (Mtz r ; 67.8%), clarithromycin (Cla r ; 62.9%), and to both antimicrobials (Mtz r Cla r ; 39.8%) were expectedly high. We also observed a large number (n ϭ 150; 16.1%) of ciprofloxacin-resistant isolates; detailed analysis showed that the majority of these isolates (n ϭ 95; 10.2%) were also resistant to metronidazole and clarithromycin, whereas only a minority (n ϭ 17; 1.8%) were exclusively resistant to ciprofloxacin.Previous unsuccessful eradication trials appear to be an important risk factor for the development of overall quinolone resistance and triple-drug resistance, since those patterns of resistance were more common among isolates from previously treated patients (Cip r , 17.1%; Mtz r Cla r Cip r , 11.8%) than among those derived from previously untreated individuals (Cip r , 9.5%; Mtz r Cla r Cip r , 0.0%). A chi-square test confirmed these differences to be significant at an error level of 5% (Fig. 1). Next, we also analyzed the average MICs of ciprofloxacin and compared the annual differences in the proportions of quinolone-resistant isolates.The (Fig. 2). Logistic regression analysis showed a significant positive trend for the proportions of Cip r isolates and Mtz r Cla r Cip r isolates. Similar high rates of quinolone resistance were reported from Korea (12) and Italy (...

show abstract

Section: Fig 2 Proportions Ofmentioning

confidence: 99%

Quinolone Resistance in Helicobacter pylori Isolates in Germany

Glocker

Stueger

Kist

2007

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…The superiority of a tailored therapy as a second-line approach was also demonstrated by a South-Korean prospective study (29). Furthermore, it may also prove to be a cost-effective strategy in high clarithromycin resistance regions (30,31).…”

Section: Discussionmentioning

confidence: 82%

Twelve-day quintuple regime containing four antibiotics as a rescue therapy for Helicobacter pylori eradication in the central region of Portugal

et al. 2017

View full text Add to dashboard Cite

Background: Helicobacter pylori eradication rates with standard triple therapy in many countries are clinically unacceptable. Fluoroquinolone resistance is increasing and jeopardizing secondline regimens. There is a growing need for an effective strategy in patients who failed previous therapies.Methods: This is a single-center, non-randomized clinical study conducted in the central region of Portugal. Sixty-four patients were included with a positive 13 C-urea breath test (UBT) or histology for H. pylori, and at least one failed eradication attempt. The patient cohort included 71.7% of females with a median of age of 52 (range 23-87). They were treated with a twelve-day regimen consisting of a proton-pump inhibitor (PPI) bid, amoxicillin at 1,000 mg 12/12h and levofloxacin at 500 mg bid during the first seven days, followed by PPI bid, clarithromycin at 500 mg 12/12 h and either tinidazole or metronidazole at 500 mg bid/tid for five days. Eradication was assessed by UBT. The local Ethics Committee approved this study.Results: Eradication therapy was prescribed due to dyspepsia (66.7%), peptic ulcer (10%) and thrombocytopenia (8.3%). The median number of failed therapies was one (range 1-4). The eradication rate was 64.6% according to an intention-to-treat analysis (95% CI: 53-77%), and 70% by the per-protocol analysis (95% CI: 58-82%). Age, smoking, indication for eradication, previous therapies and the use of a second-generation or full-dose PPI did not affect success rates.Conclusions: Even though treatment with four antibiotics was used, this "reinforced" therapy achieved suboptimal results. This fact highlights the lack of effective H. pylori antimicrobials and suggests that second-line treatment in our region should be prescribed according to susceptibility testing.

show abstract

“…Of the six potential eligible articles, we excluded another one which focused on second-line treatment for H. pylori infection (39). Five RCTs (n=701 patients) were included at last (28)(29)(30)(31)(32). The quality of the included studies is shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have evaluated the relationship between pre-treatment antibiotic resistance and eradication rate using different standard treatments and performing a susceptibility test before the initiation of the therapeutic regimen (22)(23)(24)(25). Accumulating evidences [included randomized controlled trials (RCTs)] suggest antibiotic sensitivity testing results in improving eradication rate (26)(27)(28)(29)(30)(31). Nevertheless, the effects still remain controversial (32)(33)(34).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is Antimicrobial Susceptibility Testing Necessary Before First-line Treatment for Helicobacter pylori Infection? -Meta-analysis of Randomized Controlled Trials-

Wang

Guan

et al. 2010

Intern. Med.

View full text Add to dashboard Cite

was used as a measure of the effect of two regimens mentioned above with a fixed-effects model using the methods of DerSimonian and Laird. Results Five randomized controlled trials totaling 701 patients were included. The meta-analysis showed that culture-guided triple therapy was superior referring to a higher eradication rate from intention-to-treat analyses (RR, 0.84; 95% CI,0.77, 0.90; p<0.00001) and a lower overall cost. Conclusion Culture-guided triple therapy was more effective than standard triple therapy for first-line treatment of Helicobacter pylori infection. Based on the only paper focused on the overall cost, the cultureguided triple therapy was also more cost saving. Antimicrobial susceptibility testing is necessary before firstline treatment for Helicobacter pylori infection.

show abstract

Pretreatment antimicrobial susceptibility testing is cost saving in the eradication of Helicobacter pylori

Cited by 83 publications

References 17 publications

Quinolone Resistance in Helicobacter pylori Isolates in Germany

Quinolone Resistance in Helicobacter pylori Isolates in Germany

Twelve-day quintuple regime containing four antibiotics as a rescue therapy for Helicobacter pylori eradication in the central region of Portugal

Is Antimicrobial Susceptibility Testing Necessary Before First-line Treatment for Helicobacter pylori Infection? -Meta-analysis of Randomized Controlled Trials-

Contact Info

Product

Resources

About