Effectiveness of Antiinfectives

McLoughlin, Ramona; O’Moráin, Colm

doi:10.1159/000087250

Cited by 7 publications

(5 citation statements)

References 79 publications

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“…Compared to data generated in Europe, the resistance rates observed in our study were lower (12). One possible reason to account for this difference may be that for Japanese national health care reimbursement purposes, the use of MNZ is currently restricted to use as an antiprotozoal drug, resulting in less exposure for the development of antibacterial resistance.…”

Section: Discussioncontrasting

confidence: 73%

Changing Antimicrobial Susceptibility Epidemiology of Helicobacter pylori Strains in Japan between 2002 and 2005

et al. 2007

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Surveillance ofWith a resistance rate of 19.2% among males compared to 27.0% among females, a significant gender difference was observed (P < 0.0001). Our study shows that in Japan, there is an evolving trend towards increased resistance to clarithromycin with geographical and gender differences as well as between clinical disease conditions. No significant changes in resistance were observed for amoxicillin and metronidazole during the period. While the benefit of H. pylori antimicrobial susceptibility testing has been debated in Japan, current empirical regimens are not based on susceptibility data representative of the general population. The development of an effective H. pylori eradication regimen in Japan will require continued resistance surveillance as well as a better understanding of the epidemiology of resistance.

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Section: Discussioncontrasting

confidence: 73%

Changing Antimicrobial Susceptibility Epidemiology of Helicobacter pylori Strains in Japan between 2002 and 2005

et al. 2007

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“…Twenty-five H. pylori isolates were selected for the agar dilution test with levofloxacin zone sizes less than 30 mm. The MICs of antibiotics are shown in table 1 . Among 25 selected strains tested, 22 strains were confirmed to be resistant to levofloxacin by the agar dilution method with MICs greater than 1 g/ml.…”

Section: Resultsmentioning

confidence: 99%

“…We reported previously that most of our clarithromycin-resistant H. pylori had A2144G point mutation [4] . Besides, metronidazole resistance in H. pylori might be due to poor drug penetration, decreased nitroreduction within the organism, enhanced DNA repair mechanisms [24] or the mutational inactivation of rdxA gene [1,25] . But the resistance mechanisms for levofloxacin-resistant H. pylori in Hong Kong have not been reported.…”

Section: Discussionmentioning

confidence: 99%

Levofloxacin-Resistant <i>Helicobacter pylori </i>in Hong Kong

Lee

Lee²,

Chan

et al. 2007

Chemotherapy

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Background: Fluoroquinolone-resistant Helicobacter pylori emerged in 1995 and the resistance was due to point mutation in the gyrA gene. In this study we investigate the resistance mechanism and the antimicrobial susceptibilities of clarithromycin, metronidazole, amoxicillin, tetracycline and telithromycin against levofloxacin-resistant H. pylori in Hong Kong. Methods: One hundred and ninety-one nonduplicate H. pylori isolates were collected during 2004 and 2005, and 25 isolates with levofloxacin zone sizes less than 30 mm were selected for minimal inhibitory concentration determination by agar dilution, gyrA gene amplication and sequencing the amplified gyrA gene. Results: The prevalence of levofloxacin-resistant H. pylori was 11.5% (22/191). Among these levofloxacin-resistant strains, 7 (31.8%) and 10 (45.5%) were resistant to clarithromycin and metronidazole, respectively, 17 (77.3%) had point mutations in gyrA gene at amino acids 87, 91 and 130 and the most frequent mutation point was at position 91. Conclusions: Amoxicillin, tetracycline and telithromycin were active against levofloxacin-resistantH. pylori and levofloxacin resistance was mainly due to point mutation in the gyrA gene, especially at amino acid position 91.

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“…The very fact that new antimicrobial combinations are being explored, the results of which appear regularly in the medical literature, is evidence that no single regimen serves to provide the ideal treatment the clinicians require. Antimicrobial-related adverse effects represent the main cause of poor compliance, which often lead to eradication failure [21, 23, 64]. This is, for instance, the case of rifabutin-based regimens, which – despite the high cure rates [65,66,67] – are not devoid of serious adverse events [42, 43].…”

Section: Discussionmentioning

confidence: 99%

Eradication of <i>Helicobacter pylori</i>: Are Rifaximin-Based Regimens Effective?

Gasbarrini

Pelosini

et al. 2006

Digestion

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Rifaximin is a non-absorbed semisynthetic rifamycin derivative with a broad spectrum of antibacterial activity including Gram-positive and Gram-negative bacteria, both aerobes and anaerobes. Although originally developed for the treatment of infectious diarrhea, the appreciation of the pathogenic role of gut bacteria in several organic and functional gastrointestinal diseases has increasingly broadened its clinical use. Being the antibiotic active against Helicobacter pylori, even towards clarithromycin-resistant strain, and being the primary resistance very rare, several investigations explored its potential use for eradication of the microorganism. Rifaximin alone proved to be effective, but even the highest dose (1,200 mg daily) gave a cure rate of only 30%. Dual and triple therapies were also studied, with the better results obtained with rifaximin-clarithromycin and rifaximin-clarithromycin-esomeprazole combinations. However, the eradication rates (60–70%) obtained with these regimens were still below the standard set by the Maastricht Consensus guidelines. Although rifaximin-based eradication therapies are promising, new antimicrobial combinations (with and without proton pump inhibitors) need to be explored in well-designed clinical trials including a large cohort of H. pylori-infected patients. The remarkable safety of rifaximin will allow high-dose regimens of longer duration (e.g. 10 or 14 days) to be tested with confidence in the hope of achieving better eradication rates. A drawback of rifaximin could be its inability to reach sufficiently high concentrations in the gastric mucus layer under and within which H. pylori is commonly located and this would likely affect eradication rate. Taking these considerations into account, bioadhesive rifaximin formulations able to better and persistently cover gastric mucosa, or combination with mucolytic agents, such as pronase or acetylcysteine, need to be evaluated in order to better define the place of this antibiotic in our therapeutic armamentarium.

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Effectiveness of Antiinfectives

Cited by 7 publications

References 79 publications

Changing Antimicrobial Susceptibility Epidemiology of Helicobacter pylori Strains in Japan between 2002 and 2005

Changing Antimicrobial Susceptibility Epidemiology of Helicobacter pylori Strains in Japan between 2002 and 2005

Levofloxacin-Resistant <i>Helicobacter pylori </i>in Hong Kong

Eradication of <i>Helicobacter pylori</i>: Are Rifaximin-Based Regimens Effective?

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