Objectives: National and international guidelines recommend empiric first-line treatments of individuals infected with Helicobacter pylori without prior antimicrobial susceptibility testing. For this reason, knowledge of primary resistance to first-line antibiotics such as clarithromycin is essential. We assessed the primary resistance of H. pylori in Germany to key antibiotics by molecular genetic methods and evaluated risk factors for the development of resistance. Methods: Gastric tissue samples of 1851 yet treatment-naïve H. pylori-positive patients were examined with real-time PCR or PCR and Sanger sequencing for mutations conferring resistance to clarithromycin, levofloxacin and tetracycline. Clinical and epidemiological data were documented and univariable and multivariable logistic regression analyses were conducted. Results: Overall primary resistances were 11.3% (210/1851) to clarithromycin, and 13.4% (201/1497) to levofloxacin; resistance to tetracycline (2.5%, 38/1497) was as low as combined resistance to clarithromycin/levofloxacin (2.6%, 39/1497). Female sex and prior antimicrobial therapies owing to unrelated bacterial infections were risk factors for clarithromycin resistance (adjusted OR (aOR) 2.3, 95% CI 1.6e3.4; and 2.6, 95% CI 1.5e4.5, respectively); older age was associated with levofloxacin resistance (aOR for those 65 years compared with those 18e35 years: 6.6, 95% CI 3.1e14.2). Conclusions: Clarithromycin might still be recommended in first-line eradication therapies in yet untreated patients, but as nearly every tenth patient may carry clarithromycin-resistant H. pylori it may be advisable to rule out resistance ahead of treatment by carrying out susceptibility testing or prescribing an alternative therapy.

After oral administration of 500 mg of levofloxacin to 12 volunteers, we investigated the pharmacokinetics and serum bactericidal activities (SBAs) against five strains of members of the family Enterobacteriaceae. Pharmacokinetic data were as follows: maximum concentration in serum, 6.36 ؎ 0.57 mg/liter; area under the concentration-time curve, 43.6 ؎ 6.23 mg ⅐ h/liter; elimination half-life 4.23 ؎ 0.87 h. SBAs were present for 24 h against Escherichia coli and Citrobacter freundii. The SBAs at 1, 12, and 24 h after administration against E. coli were 1:108, 1:29, and 1:7, respectively, and those against Citrobacter freundii were 1:74, 1:25, and 1:7, respectively. The SBAs were present for 12 h against the other three organisms tested. The SBAs against Serratia marcescens were 1:28 and 1:9 at 1 and 12 h, respectively; the SBAs against Klebsiella pneumoniae were 1:25 and 1:7 at 1 and 12 h, respectively; and the SBAs against Enterobacter cloacae were 1:24 and 1:10 at 1 and 12 h, respectively.Levofloxacin is the active L-isomer of the racemate ofloxacin, a fluoroquinolone with a broad spectrum of activity (5,14). We assessed the pharmacokinetics of levofloxacin and the serum bactericidal activities (SBAs) against five different species of members of the family Enterobacteriaceae. Twelve healthy female volunteers (mean age, 33.8 Ϯ 6.1 years; mean body weight, 64.1 Ϯ 10.2 kg) were included after they provided written informed consent. Exclusion criteria were hypersensitivity to quinolones, pregnancy, drug or alcohol abuse, or the use of a concomitant medication except for contraceptives. The study was approved by the ethical committee of the Physicians' Association of Hessen, Frankfurt, Germany.Levofloxacin (lot HR355/1014, batch no. 20; Hoechst, Frankfurt, Germany) was administered orally as an open single dose of 500 mg (in tablet form) on an empty stomach after 10 h of fasting. Blood samples were collected just before medication and at 0.5, 1,2,4,6,8,12, and 24 h after medication. Serum levofloxacin concentrations were determined enantioselectively by high-performance liquid chromatography by a previously described method (12). The assay was linear over the concentration range studied, and the lower limit of quantitation was 20 ng/ml. The inter-and intraday coefficients of variation were both Ͻ3%.We analyzed 10 clinically relevant strains of five different species of the family Enterobacteriaceae isolated by the Department of Clinical Microbiology of the City Hospital Zehlendorf/ Heckeshorn and of the Departments of Microbiology of the University Hospitals Benjamin-Franklin and Charité-Virchow, Berlin, Germany. The species of all isolates were determined with the API 20E system (API BioMérieux, Nürtingen, Germany). The minimal bactericidal concentrations (MBCs) of levofloxacin were determined in triplicate by the standardized microdilution method described in the guidelines of the National Committee for Clinical Laboratory Standards (NCCLS) (16). All samples were serially diluted in a 96-well plate (Falcon; Becton...

A 33-year-old refugee from Nigeria, who had been living in Germany for 1 year, was admitted to the hospital due to pelvic pain, peranal hemorrhage, and an unexplained increase in transaminase levels. As the liver screening tests, sonography findings, and colonoscopy were normal, a liver biopsy was performed that revealed Schistosoma mansoni worm eggs as an unexpected diagnostic finding. Serological tests for specific antibodies and parasitological egg detection in the stool confirmed the diagnosis. After only temporary response to a short-term and low-dose treatment with praziquantel, a 3-day high-dose (40 mg/kg body weight) treatment with praziquantel finally led to long-lasting symptom relief.