Primary antibiotic resistance in <i>Helicobacter pylori</i> strains isolated in northern and central Italy

Zullo, Angelo; Perna, Francesco; Hassan, Cesare; Ricci, Chiara; Saracino, Ilaria Maria; Morini, Sergio; Vaira, Dino

doi:10.1111/j.1365-2036.2007.03331.x

Cited by 104 publications

(93 citation statements)

References 41 publications

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“…Moreover, two metaanalyses have demonstrated a lower incidence of adverse effects with levofloxacin-based treatments than with the quadruple combinations [88,89] . Unfortunately, it has been shown that resistance to quinolones is easily acquired, and in countries with a high consumption of these drugs, the resistance rate is increasing and is already relatively high [94,103,107,[113][114][115][116][117][118][119][120][121][122][123] . More importantly, it has been demonstrated that the presence of levofloxacin resistance significantly reduce the eradication rate following a therapy with this antibiotic [94,103,121,124] .…”

Section: Rbc Tetracycline and Metronidazolementioning

confidence: 99%

“Rescue” regimens after Helicobacter pylori treatment failure

Gisbert¹

2008

WJG

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Helicobacter pylori (H pylori ) infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. After more than 20 years of experience in H pylori treatment, in my opinion, the ideal regimen to treat this infection is still to be found. Currently, apart from having to know first-line eradication regimens well, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a "rescue" treatment depends on which treatment is used initially. If a clarithromycinbased regimen was used initially, a subsequent metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacinbased combination would be a third "rescue" option. Alternatively, it has recently been suggested that levofloxacin-based rescue therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, a quadruple regimen may be reserved as a third-line rescue option. Finally, rifabutin-based rescue therapy constitutes an encouraging empirical fourthline strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H pylori eradication can finally be achieved in almost all patients if several rescue therapies are consecutively given. Therefore, the attitude in H pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.

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Section: Rbc Tetracycline and Metronidazolementioning

confidence: 99%

“Rescue” regimens after Helicobacter pylori treatment failure

Gisbert¹

2008

WJG

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“…Unfortunately, it has been shown that resistance to quinolones is easily acquired, and in countries with a high consumption of these drugs, the resistance rate is increasing and is already relatively high [Carothers et al 2007;Cattoir et al 2007;Glocker et al 2007;Perna et al 2007;Zullo et al 2007;Bogaerts et al 2006;Kim et al 2006;Marzio et al 2006;Miyachi et al 2006;Wong et al 2006;Coelho et al 2005;Gatta et al 2005;Cammarota et al 2004;Cabrita et al 2000]. More importantly, it has been demonstrated that the presence of levofloxacin resistance significantly reduce the eradication rate following a therapy with this antibiotic Marzio et al 2006;Gatta et al 2005;Krakowka et al 1996].…”

Section: Introductionmentioning

confidence: 99%

Review: Second-line rescue therapy of Helicobacter pylori infection

Gisbert

2009

Therap Adv Gastroenterol

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Helicobacter pylori infection is the main known cause of gastritis, gastroduodenal ulcer disease and gastric cancer. After more than 20 years of experience in H. pylori treatment, however, the ideal regimen to treat this infection has still to be found. Nowadays, apart from having to know well first-line eradication regimens, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a 'rescue' treatment depends on which treatment is used initially. If a first-line clarithromycin-based regimen was used, a second-line metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacin-based combination would be a third-line 'rescue' option. Alternatively, it has recently been suggested that levofloxacin-based 'rescue' therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, quadruple regimen may be reserved as a third-line 'rescue' option. Finally, rifabutin-based 'rescue' therapy constitutes an encouraging empirical fourth-line strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H. pylori eradication can finally be achieved in almost all patients if several 'rescue' therapies are consecutively given. Therefore, the attitude in H. pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.

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“…As the authors suggest, the lower efficacy of eradication therapy in immigrants may depend on a higher antibiotic resistance. However, a recent study performed in Bulgaria shows a 15.4% primary clarithromycin resistance rate [9], a value very similar to the 16.9% quoted in Italy [10]. Moreover, the therapeutic regimen chosen by Gatta et al [4] did not include metronidazole for which primary resistance rate is high in H. pylori strains isolated in the East population.…”

mentioning

confidence: 83%

“…Moreover, the therapeutic regimen chosen by Gatta et al [4] did not include metronidazole for which primary resistance rate is high in H. pylori strains isolated in the East population. Indeed, they administered amoxicillin for which primary resistance was very low both in Bulgaria (1.1%) and in Italy [9,10]. Therefore, it is likely that the lower eradication rate observed in immigrants depends on a low rate of compliance with therapy rather than on a high antibiotic resistance rate.…”

mentioning

confidence: 99%