Review article: the global emergence ofHelicobacter pyloriantibiotic resistance

Abstract

SummaryBackground Helicobacter pylori is one of the most prevalent global pathogens and can lead to gastrointestinal disease including peptic ulcers, gastric marginal zone lymphoma and gastric carcinoma.AimTo review recent trends in H. pylori antibiotic resistance rates, and to discuss diagnostics and treatment paradigms.MethodsA PubMed literature search using the following keywords: Helicobacter pylori, antibiotic resistance, clarithromycin, levofloxacin, metronidazole, prevalence, susceptibility testing.ResultsThe prevalence of bacterial antibiotic resistance is regionally variable and appears to be markedly increasing with time in many countries. Concordantly, the antimicrobial eradication rate of H. pylori has been declining globally. In particular, clarithromycin resistance has been rapidly increasing in many countries over the past decade, with rates as high as approximately 30% in Japan and Italy, 50% in China and 40% in Turkey; whereas resistance rates are much lower in Sweden and Taiwan, at approximately 15%; there are limited data in the USA. Other antibiotics show similar trends, although less pronounced.ConclusionsSince the choice of empiric therapies should be predicated on accurate information regarding antibiotic resistance rates, there is a critical need for determination of current rates at a local scale, and perhaps in individual patients. Such information would not only guide selection of appropriate empiric antibiotic therapy but also inform the development of better methods to identify H. pylori antibiotic resistance at diagnosis. Patient‐specific tailoring of effective antibiotic treatment strategies may lead to reduced treatment failures and less antibiotic resistance.

Eradication Rates in Italian Subjects Heterogeneously Managed for Helicobacter pylori Infection. Time to Abandon Empiric Treatments in Southern Europe

“…However, this drug became available in Italy only from March 2016, and data on its efficacy in southern Italy are still scarce. Our data confirm the high eradication rates with Pylera®, which seems able to overwhelm the limits linked to antibiotic resistance in the explored geographical area, characterized by a clarithromycin resistance rate higher than 15% [6,7,13,16,41].…”

“…However, as expected in an area where clarithromycin resistance is quite high -approximately 30% in Italy [6,13,16,41], and >15% in Apulia [7], the eradication rate was low and below what should be expected for an infectious disease [5,42]. In this respect, some additional considerations are required: i) the rising prevalence of clarithromycin-resistant H. pylori in southern Europe [41,43] and therefore in Italy [13], with regional differences [7], makes the PPI-clarithromycin-containing triple therapy unacceptable [5], at least in these geographical areas; ii) the duration of the PPI-clarithromycin-containing triple therapy was 7 days in our area, instead of 10 or 14 days, a policy aimed to further increase the success rate by another 4-5% [5] and possibly >80% [44,45] and, iii) the majority of PPI-clarithromycin-containing triple therapy used the PPI omeprazole 20 mg twice daily, instead of the more potent second-generation PPIs, i.e.…”

“…Of note, clarithromycin resistance is J Gastrointestin Liver Dis, June 2017 Vol. 26 No 2: 129-137 rapidly increasing worldwide [6] and this trend undermines the efficacy of the standard first-line triple (proton pump inhibitor -PPI, amoxicillin, clarithromycin) therapy, yielding a low eradication rate (<80%) [7][8][9]. Other first-line regimens included the "sequential" (PPI, amoxicillin followed by clarithromicin and tinidazole) therapy [9][10][11].…”

Efficacy and Tolerability of Second-Line Metronidazole Triple Therapy Using Vonoprazan for Helicobacter pylori Eradication in Japan—Comparative Study: Vonoprazan vs. Proton Pump Inhibitors

“…According to antimicrobial susceptibility testing in Japan, the MNZ resistance rate after eradication therapy increased from 3% without an eradication history to 13.3% after first-line therapy failure and 52.4% for secondline therapy failure [30]. In the future, MNZ resistance rates will increase in Japan as in many countries [31].…”

Маастрихтський Консенсус-5: Аналітичний Огляд Положень

“…Для неинвазивной оценки состояния слизистой оболочки желудка (атрофическая или неатрофиче-ская) у части больных может быть использована панель серологических тестов (GastroPanel), которая вклю-чает определение пепсиногенов (Pg) І и ІІ, гастри-на-17 (G-17) и антител к H. pylori [31].…”