Trend of changes in antibiotic resistance in Helicobacter pylori from 2013 to 2019: a multicentre report from Taiwan

Abstract

Background: Antibiotic resistance plays a crucial role in the treatment failure of Helicobacter pylori (H. pylori) infection. This study aimed to determine the trend of changes in the primary, secondary and tertiary antibiotic resistance of H. pylori in Taiwan over the last 7 years. Methods: We retrospectively analysed H. pylori-infected isolates from patients with primary resistance ( n = 1369), secondary resistance ( n = 196) and tertiary resistance ( n = 184) from January 2013 to December 2019. The H. pylori strains were tested for susceptibility to amoxicillin, clarithromycin, levofloxacin, metronidazole and tetracycline using the Epsilometer test method. Results: A progressively higher primary resistance rate was observed for clarithromycin (11.8–20.4%, p = 0.039 in χ2 test for linear trend), levofloxacin (17.3–38.8%, p < 0.001) and metronidazole (25.6–42.3%, p < 0.001) among naïve patients who received first-line eradication therapy. The dual primary resistance to clarithromycin and metronidazole also progressively increased in a linear trend (2.4–10.4%, p = 0.009). For secondary resistance, an increase was observed for levofloxacin (30.5–64.7%, p = 0.006) and metronidazole (40.5–77.4%, p < 0.001). For tertiary resistance, the observed increase was even more significant for levofloxacin (65.9–100.0%, p = 0.106) and metronidazole (44.4–88.2%, p < 0.001). The resistance to amoxicillin and tetracycline remained very low in Taiwan regardless of primary, secondary and tertiary resistance. Conclusion: Primary, secondary and tertiary antibiotic resistance to clarithromycin, levofloxacin and metronidazole for H. pylori has been increasing in Taiwan since 2013. Treatment should be targeted for eradication success rates of more than 90%. Third-line treatment should be based on antibiotic susceptibility.

Tetracycline‐levofloxacin versus amoxicillin‐levofloxacin quadruple therapies in the second‐line treatment of Helicobacter pylori infection

“…A randomized controlled trial 32 demonstrated that 14‐day AL quadruple therapy achieved a higher eradication rate than 14‐day AL triple therapy for levofloxacin‐resistant strains (70.6% vs 37.5%, respectively). A recent study from Taiwan reported that the rate of resistance to levofloxacin in the second‐line treatment of H. pylori infection was 51.6% in 2019 16 . In the current study, the resistant rate for levofloxacin of H. pylori strains following the failure of first‐line therapies was 51.4%.…”

“…A recent study from Taiwan reported that the rate of resistance to levofloxacin in the secondline treatment of H. pylori infection was 51.6% in 2019. 16 In the current study, the resistant rate for levofloxacin of H. pylori strains following the failure of first-line therapies was 51.4%. Although AL quadruple therapy could yield a high eradication rate for levofloxacin-susceptible strains (90.9%), its eradication efficacy for levofloxacin-resistant strains was poor (50.0%).…”

“…An important caveat of levofloxacin‐amoxicillin triple therapy is poor eradication efficacy in the presence of fluoroquinolone resistance 13 . In Taiwan, a progressively higher primary resistance rate was observed for clarithromycin (11.8% to 20.4%), metronidazole (25.6% to 42.3%), and levofloxacin (17.3% to 38.8%) from 2013 to 2019 16 . In the second‐line treatment of H. pylori infection, the rates of resistance to tetracycline, levofloxacin, and amoxicillin in Taiwan were 0%–4%, 21%–53%, and 0%–8%, respectively 17‐20 .…”

“…13 In Taiwan, a progressively higher primary resistance rate was observed for clarithromycin (11.8% to 20.4%), metronidazole (25.6% to 42.3%), and levofloxacin (17.3% to 38.8%) from 2013 to 2019. 16 In the second-line treatment of H. pylori infection, the rates of resistance to tetracycline, levofloxacin, and amoxicillin in Taiwan were 0%-4%, 21%-53%, and 0%-8%, respectively. [17][18][19][20] The data indicate that both tetracycline and amoxicillin are good candidates for antibiotics adopted in rescue treatment of H. pylori infection.Recently, a novel 10-day tetracycline-levofloxacin (TL) quadruple therapy has developed for rescue treatment of H. pylori infection.…”

Eradication Rates for Esomeprazole and Lansoprazole-Based 7-Day Non-Bismuth Concomitant Quadruple Therapy for First-Line Anti-Helicobacter pylori Treatment in Real World Clinical Practice

“…Furthermore, the primary dual resistance to clarithromycin and metronidazole also significantly increased in a linear trend from 2.4% to 10.4% (p = 0.009). 33 The eradication rate of non-bismuth concomitant quadruple therapy in first-line therapy could be expected to drop further to < 90% in Taiwan as time goes by. Therefore, continuously monitoring regional resistance rates was mandatory.…”