Effects of Primary Metronidazole and Clarithromycin Resistance to Helicobacter pylori on Omeprazole, Metronidazole, and Clarithromycin Triple-Therapy Regimen in a Region with High Rates of Metronidazole Resistance

Abstract

The aim of this study was to investigate the effect of metronidazole resistance (MtzR) and clarithromycin resistance (ClaR) on the eradication rate for omeprazole, clarithromycin, and metronidazole triple-therapy regimen and on the development of posttherapy drug resistance in a region of high rates of MtzR. One hundred ninety-six Helicobacter pylori isolates were recovered from patients with duodenal ulcer, gastric ulcer, or nonulcer dyspepsia during upper endoscopy. The prevalences of MtzR, ClaR, and dual resistance were 37.8%, 13.8%, and 8.7%, respectively. The intention-to-treat eradication rates for metronidazole-susceptible (87.2% vs. 67.6%; P=.001) and clarithromycin-susceptible (86.4% vs. 40.7%; P<.001) strains were significantly higher than the rates for resistant strains. Multiple logistic regression analysis implicated younger age (<40 years old), MtzR, ClaR, and the diagnosis of nonulcer dyspepsia as independent factors that predicted treatment failure. The rates of posttreatment MtzR, ClaR, and dual resistance were 88%, 88%, and 75%, respectively. MtxR and ClaR significantly affected the success of eradication therapy. Posttreatment rates of resistance were high and were related to the presence of pretreatment antibiotic resistance.

Update on Clarithromycin Resistance in <i>Helicobacter pylori</i> in Hong Kong and Its Effect on Clarithromycin-Based Triple Therapy

“…The present study showed that the primary resistance rate of H. pylori to metronidazole and clarithromycin in Hong Kong was 39.2 and 7.8% respectively in 2004, which was within the range of those observed in previous studies in Hong Kong (25.2–71.4% for metronidazole resistance and 2.7–13.8% for clarithromycin resistance)[7, 8, 16]. The prevalence of clarithromycin resistance falls within the data reported worldwide, including China (10%) [17], Japan (11%) [18], the USA (10.1%) [19], Germany (2.2%) [20], and the UK (5.3%) [21].…”

“…At present, 1-week triple therapy based on a proton pump inhibitor (PPI) in standard doses plus two of antibiotics consisting of clarithromycin plus either amoxicillin or metronidazole is recommended as a standard treatment [1]. However, widespread prescription with antibiotics may lead to resistance of H. pylori to antibiotics, which is confirmed to be a main cause of treatment failure [7]. …”

Standard treatment for Helicobacter pylori infection is suboptimal in non‐ulcer dyspepsia compared with duodenal ulcer in Chinese

“…Bacterial resistance to metronidazole or clarithromycin is an important factor leading to treatment failure. Primary resistance to metronidazole and clarithromycin is common in Chinese population and significantly affects the efficacy of standard H. pylori eradication therapy 15, 16 . The reason for the therapeutic difference observed is unknown but may be related to the difference in H. pylori strains harboured by these infected individuals, as cagA ‐ and vacA ‐positive strains were more commonly found in patients with PUD.…”

First-line therapy in Helicobacter pylori eradication therapy: experience of a surgical clinic

“…Before the 2000s, the standard triple treatments were said to have up to 95% of success rates (17). However, especially with the increasing resistance to CLA over time, this rate dropped to 55% (21). From there on, there has been an inclination for protocols that contain BS.…”

“…The eradication rate of 78.5% in the BPMT group is far from meeting expectations, although it is quite higher than the LAC group. The increasing MET resistance both in the world and in our country in recent years can be proposed as the reason of this (2,6,21).…”