Role of MIC levels of resistance to clarithromycin and metronidazole in <i>Helicobacter pylori</i> eradication

Francesco, Vincenzo De; Zullo, Angelo; Fiorini, Giulia; Saracino, Ilaria Maria; Pavoni, Matteo; Vaira, Dino

doi:10.1093/jac/dky469

Cited by 29 publications

(33 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…High‐dose proton pump inhibitor and rifabutin in combination have been suggested to be superior than rifabutin with standard dose proton pump inhibitor, which we prescribed to all of our rifabutin‐receiving patients . Finally, and in contrast to levofloxacin, metronidazole resistance in vitro may be overcome with the addition of high‐dose proton pump inhibitor in vivo, a known phenomenon which our experience also supports …”

Section: Discussionsupporting

confidence: 64%

“…18,23 Finally, and in contrast to levofloxacin, metronidazole resistance in vitro may be overcome with the addition of high-dose proton pump inhibitor in vivo, a known phenomenon which our experience also supports. 24,25 To our knowledge, this is the first study describing a regional pattern of HP resistance in the United States and certainly the first in the Delaware Valley region of the Eastern Seaboard. Resistant HP is poorly described and catalogued in the US in general, and it is an important public health concern.…”

Section: Discussionmentioning

confidence: 88%

See 1 more Smart Citation

Resistance patterns of refractory Helicobacter pylori infection in a referral centre in the Delaware Valley

et al. 2020

View full text Add to dashboard Cite

Summary Introduction Helicobacter pylori (HP) resistance is increasing in the US. Guidelines suggest treatment based on local resistance patterns, yet are poorly studied. Here, we describe resistance patterns of the Delaware Valley. Methods Retrospective study of patients referred to the Hospital of the University of Pennsylvania, between 2009 and 2019 who underwent endoscopy for culture. Chart review identified demographics, history, endoscopic and culture results, treatment and follow‐up. Results Of 109 patients referred for refractory HP, 90 had identified HP. Median age was 53.2 years and the majority was female (74%), with a median two previous antibiotic courses for HP. Gastric erythema was the most common endoscopic abnormality. Sixty‐five (72.2%) were culture positive, and 45 (69.2%) were resistant to levofloxacin, 27 (41.5%) to metronidazole and 39 (43.3%) to clarithromycin. Being resistant to any one of the three antibiotics was associated with resistance to either of the other two. There was an association with number of previous antibiotics with resistance (OR 1.74, P < 0.05). We prescribed therapy to 77 patients based on susceptibility profiles, and 34 (37.8%) were cured, 14 (15.6%) underwent endoscopic surveillance, 3 (3.3%) were followed by infectious disease, and 39 (43.3%) were lost to follow up. Conclusions Antibiotic resistance is associated with refractory HP, and continues to rise. Culturing is associated with cure, and its use in clinical practice regarding efficacy, cost‐effectiveness and ability to minimise antibiotic resistance should be further studied. Overall follow‐up is limited by loss to follow‐up, emphasising the need for appropriate treatment.

show abstract

Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 88%

Resistance patterns of refractory Helicobacter pylori infection in a referral centre in the Delaware Valley

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Since H pylori resistance to amoxicillin and tetracycline is uncommon, the explanation for the heterogeneous results could be that both amoxicillin and tetracycline are weak against H pylori or there is a possible antagonistic effect . Recent studies have suggested that a high level of resistance to metronidazole, at an MIC >32 μg/mL, could be a reliable predictor of eradication failure of bismuth‐containing quadruple therapy . In addition, other salvage regimens are needed in patients with high‐level metronidazole resistance for customized tailored therapy through antibiotic susceptibility tests.…”

Section: Discussionmentioning

confidence: 99%

“…31 Recent studies have suggested that a high level of resistance to metronidazole, at an MIC >32 μg/mL, could be a reliable predictor of eradication failure of bismuth-containing quadruple therapy. 11,32 In addition, other salvage regimens are needed in patients with high-level metronidazole resistance for customized tailored therapy through antibiotic susceptibility tests.…”

Section: Discussionmentioning

confidence: 99%

Primary and secondary antibiotic resistance of Helicobacter pylori in Korea from 2003 to 2018

et al. 2019

View full text Add to dashboard Cite

Background Antimicrobial resistance of Helicobacter pylori (H pylori) affects the efficacy of eradication therapy. The aim of this study was to estimate the prevalence of primary and secondary resistance of H pylori isolates to antibiotics in Korea. Methods The present study was performed from 2003 to 2018. Primary resistance was evaluated in 591 patients without any history of eradication and secondary resistance in 149 patients from whom Helicobacter pylori was cultured after failure of eradication. A minimal inhibitory concentration test was performed for amoxicillin, clarithromycin, metronidazole, tetracycline, levofloxacin, and rifabutin using the agar dilution method. Results An increase in the primary resistance rate was found in clarithromycin (P < .001), metronidazole (P < .001), and both levofloxacin (P < .001) during the study period. The primary resistance rates of amoxicillin and tetracycline were low and stable during the study period. The secondary resistance rate significantly increased in metronidazole and levofloxacin (P = .022 and .039, respectively). Conclusions The primary and secondary resistance rates of clarithromycin, metronidazole, and levofloxacin for Helicobacter pylori in Korea were high and increased over time. However, the primary and secondary resistance rates of amoxicillin and tetracycline were low and stable over time. These results will help in selecting effective eradication regimens of H pylori in Korea in the future.

show abstract

“…5 μg/mL [17]. MIC values were classified into low (MIC from >0.5 to ≤8 μg/mL) and high (MIC from >8 to 256 μg/mL) groups [18].…”

Section: Antibiotic Susceptibilitymentioning

confidence: 99%

Molecular Assessment of Resistance to Clarithromycin in Helicobacter pylori Strains Isolated from Patients with Dyspepsia by Fluorescent In Situ Hybridization in the Center of Iran

Vazirzadeh

Falahi

Moghim

et al. 2020

BioMed Research International

View full text Add to dashboard Cite

Background and Aims. Helicobacter pylori is a common infectious bacterium mostly found in gastroduodenal diseases. The increased prevalence of clarithromycin-resistant H. pylori strains is a major challenge in the successful treatment of infections caused by this organism. The present study is aimed at detecting the clarithromycin resistance pattern of H. pylori strains isolated from gastric biopsies and evaluating point mutations of the 23S rRNA gene. Patients and methods. In the present descriptive cross-sectional study, 165 patients with gastrointestinal disorders, who were referred to the Endoscopy Center of Dr. Shariati Hospital of Isfahan, Iran, were enrolled from April to July 2018. H. pylori infection was diagnosed by culture, and susceptibility of the isolates to clarithromycin was assessed by the E-test. Minimum inhibitory concentration (MIC) values were obtained based on EUCAST recommendations. Also, fluorescence in situ hybridization (FISH) was used to determine point mutations associated with clarithromycin resistance. Results. By using culturing, H. pylori was isolated from 50.3% (83/165) gastric biopsy specimens. The overall frequency of resistance to clarithromycin was 25.3% (21/83) by the E-test. In the resistance genotypic analysis, 19 isolates had mutations. The prevalence of A2143G and A2144G mutations was 68.4% (13/19) and 31.5% (6/19), respectively. A2143C mutation was not tracked in any isolate. Two isolates with MIC > 0:5 μg/mL had no mutations that could be related to other mechanisms of resistance. Conclusion. As presented in the study, the high prevalence of clarithromycin-resistant H. pylori due to point mutations of the 23S rRNA gene indicates the necessity of revising the standard treatment regimen based on antibiotic susceptibility pattern of each region.

show abstract

Role of MIC levels of resistance to clarithromycin and metronidazole in Helicobacter pylori eradication

Cited by 29 publications

References 10 publications

Resistance patterns of refractory Helicobacter pylori infection in a referral centre in the Delaware Valley

Resistance patterns of refractory Helicobacter pylori infection in a referral centre in the Delaware Valley

Primary and secondary antibiotic resistance of Helicobacter pylori in Korea from 2003 to 2018

Molecular Assessment of Resistance to Clarithromycin in Helicobacter pylori Strains Isolated from Patients with Dyspepsia by Fluorescent In Situ Hybridization in the Center of Iran

Contact Info

Product

Resources

About