Age of eradication and failure rates of clarithromycin‐containing triple therapy for<i>Helicobacter pylori</i>: A 15‐year population‐based study

Jiang, Fang; Guo, Chuan‐Guo; Cheung, Ka Shing; Li, Bofei; Law, Simon; Leung, Wai Keung

doi:10.1111/hel.12893

Cited by 9 publications

(20 citation statements)

References 38 publications

(85 reference statements)

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“…Furthermore, a high dual-resistance rate to clarithromycin and metronidazole was also recorded, indicating a major public health concern as clarithromycin and metronidazole are used for sequential, hybrid, and concomitant therapies [ 5 ]. In European countries, the secondary resistance rate to clarithromycin and metronidazole was found to be 18%, while in our study, it was found to be 36.6% [ 19 ]. Culture-guided treatments and genetics analyses of H. pylori should be conducted in the future to determine the antibiotic susceptibility of H. pylori before the administration of treatment.…”

Section: Discussionmentioning

confidence: 66%

“…We also observed eradication failure tends to occur more frequently in patients aged less than 60 years old than that in patients aged more than 60 years old. A recent study on a large population also observed that the eradication failure of H. pylori occurs more in younger patients than in older patients [ 19 ]. This trend should be studied further as a failure of eradication in young people will complicate the early eradication therapy of H. pylori to prevent gastric cancer development.…”

Section: Discussionmentioning

confidence: 99%

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Multidrug-Resistant Helicobacter pylori Strains: A Five-Year Surveillance Study and Its Genome Characteristics

et al. 2022

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Background: The emergence of multidrug-resistant Helicobacter pylori has undermined eradication strategies to prevent the development of gastric cancer. This study was conducted to estimate the prevalence of secondary antibiotic resistance of H. pylori in urban multicultural areas in Malaysia. Methods: From January 2017 to December 2021, gastric biopsies from 218 patients with a history of H. pylori eradication failure were sent to our laboratory for antibiotic susceptibility testing. A minimal inhibitory concentration was determined for six antibiotics, namely metronidazole, clarithromycin, levofloxacin, amoxicillin, tetracycline, and rifampicin using the E-test method. Two multidrug-resistant H. pylori strains identified in this study were subjected to whole genome sequencing. Results: Eradication failure was observed to be significantly higher in the Malaysian Chinese patients than in the Malaysian Indian and Malay patients. H. pylori were successfully isolated from 51 patients (23.4%). Overall, the antibiotic resistance rates of H. pylori to metronidazole, clarithromycin, levofloxacin, and amoxicillin were 82.4% (42/51), 72.5% (37/51), 52.9% (27/51), and 3.9% (2/51), respectively. Resistance to tetracycline and rifampicin were not observed during the study period. Resistance to more than one antibiotic was observed in 82.4% (42/51) of the isolates, of which 42.2% (19/42) were resistant to three antibiotic classes. Resistance to both clarithromycin and metronidazole were most frequently observed in isolates with dual resistance (56.5%; 13/23). Codon substitutions in penicillin-binding protein 1A (V346L, V374L, G595_V596InsG, Y604H, and N608S) were detected in amoxicillin-resistance H. pylori strains. Herein, we report amoxicillin resistance in H. pylori isolated from Malaysian patients, and its resistance mechanism, for the first time. Conclusion: Our results show the increase trend in secondary multidrug resistance in H. pylori isolates, which warrants continuous surveillance.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Multidrug-Resistant Helicobacter pylori Strains: A Five-Year Surveillance Study and Its Genome Characteristics

et al. 2022

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“…First, the infection status after H. pylori eradication was not documented in the electronic healthcare database and was inferred by the need for retreatment for H. pylori . This approach has been used and validated in our previous studies 2,3,18–22 . Second, actual medication compliance could not be determined from this electronic healthcare database, we could only ascertain warfarin or DOACs use from prescription and dispensing records, which may cause potential misclassifications of exposure.…”

Section: Discussionmentioning

confidence: 99%

“…These patients had been prescribed their first course of clarithromycin‐containing triple therapy lasting 7–14 days, which was the main eradication regime given in Hong Kong during that period. Patients who required retreatment for H. pylori were excluded and the details of various retreatment regimes were described previously 18,22 . The accuracy of retreatment inferred eradication failure had been verified in our previous study 18 …”

Section: Methodsmentioning

confidence: 97%

“…We included all adult patients who had previously received H. pylori eradication therapy between January 1, 2003, and December 31, 2017, in Hong Kong. 18,22 These patients had been prescribed their first course of clarithromycin-containing triple therapy lasting 7-14 days, which was the main eradication regime given in Hong Kong during that period. Patients who required retreatment for H. pylori were excluded and the details of various retreatment regimes were described previously.…”

Section: Study Subjectsmentioning

confidence: 99%

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Risk of hospitalization for upper gastrointestinal bleeding in Helicobacter pylori eradicated patients newly started on warfarin or direct oral anticoagulants: A population‐based cohort study

Jiang

Guo

et al. 2023

Helicobacter

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Background: To investigate risks of hospitalization for upper gastrointestinal bleeding (UGIB) in H. pylori-eradicated patients newly started on warfarin or direct oral anticoagulants (DOACs). Methods:We identified all patients who had previously received H. pylori eradication therapy or were found to have no H. pylori on endoscopy and were then newly started on warfarin or DOACs from a population-based electronic healthcare database. Primary analysis was the risk of UGIB between warfarin and DOACs users in H. pylori-eradicated patients. Secondary analysis included the UGIB risk between H. pylori-eradicated and H. pylori-negative patients who were newly started on warfarin or DOACs. The hazard ratio (HR) of UGIB was approximated by pooled logistic regression model incorporating the inverse propensity of treatment weightings with time-varying covariables.Results: Among H. pylori-eradicated patients, DOACs had a significantly lower risk of UGIB (HR: 0.26, 95% CI 0.09-0.71) compared with warfarin. In particular, lower UGIB risks with DOACs were observed among older (≥65 years) patients, female, those without a history of UGIB or peptic ulcer, or ischemic heart disease, and non-users of acidsuppressive agents or aspirin. Secondary analysis showed no significant difference in UGIB risk between H. pylori-eradicated and H. pylori-negative patients newly started on warfarin (HR: 0.63,95% CI 0.33-1.19) or DOACs (HR: 1.37, 95% CI 0.45-4.22).Conclusions: In H. pylori-eradicated patients, new users of DOACs had a significantly lower risk of UGIB than new warfarin users. Furthermore, the risk of UGIB in new warfarin or DOACs users was comparable between H. pylori-eradicated and H. pylorinegative patients.

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Comparison of the management of Helicobacter pylori infection between the older and younger European populations

Jonaitis,

Nyssen,

Saracino

et al. 2023

Sci Rep

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The prevalence of Helicobacter pylori remains high in the older population. Specific age-related peculiarities may impact the outcomes of H. pylori treatment. The aim of the study was to evaluate the diagnostics and effectiveness of H. pylori eradication between the younger and older European populations. “European Registry on H. pylori Management (Hp-EuReg)” data from 2013 to 2022 were analyzed. Patients were divided into older (≥ 60 years) and younger (18–59 years) groups. Modified intention-to-treat (mITT) and per-protocol (PP) analysis was performed. 49,461 patients included of which 14,467 (29%) were older-aged. Concomitant medications and penicillin allergy were more frequent among the older patients. Differences between younger and older populations were observed in treatment duration in first-line treatment and in proton pump inhibitors (PPIs) doses in second-line treatment. The overall incidence of adverse events was lower in the older adults group. The overall first-line treatment mITT effectiveness was 88% in younger and 90% in the older patients (p < 0.05). The overall second-line mITT treatment effectiveness was 84% in both groups. The effectiveness of the most frequent first- and second-line triple therapies was suboptimal (< 90%) in both groups. Optimal efficacy (≥ 90%) was achieved by using bismuth and non-bismuth-based quadruple therapies. In conclusion, the approach to the diagnostics and treatment of H. pylori infection did not generally differ between younger and older patients. Main differences were reported in the concurrent medications, allergy to penicillin and adverse events both in first- and second-line treatment. Optimal effectiveness rates were mostly achieved by using bismuth and non-bismuth-based quadruple therapies. No clinically relevant differences in the effectiveness between the age groups were observed.

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Age of eradication and failure rates of clarithromycin‐containing triple therapy forHelicobacter pylori: A 15‐year population‐based study

Cited by 9 publications

References 38 publications

Multidrug-Resistant Helicobacter pylori Strains: A Five-Year Surveillance Study and Its Genome Characteristics

Multidrug-Resistant Helicobacter pylori Strains: A Five-Year Surveillance Study and Its Genome Characteristics

Risk of hospitalization for upper gastrointestinal bleeding in Helicobacter pylori eradicated patients newly started on warfarin or direct oral anticoagulants: A population‐based cohort study

Comparison of the management of Helicobacter pylori infection between the older and younger European populations

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