Eradication of Helicobacter pylori According to 23S Ribosomal RNA Point Mutations Associated With Clarithromycin Resistance

Lee, Hyun Jeong; Kim, Sang Hyun; Cheung, Dae Young; Kim, Tae Ho; Jun, Eun Jung; Oh, Jung-Hwan; Chung, Woo Chul; Kim, Byung‐Wook; Kim, Sung Soo; Park, Soo‐Heon; Kim, Jae Kwang

doi:10.1093/infdis/jit287

Cited by 92 publications

(93 citation statements)

References 23 publications

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“…There are several advantages to this method because it is relatively simple and efficient with a cost similar to a rapid urease test [135] . In a recent study of 1232 patients, the eradication rate by selective treatment in the tailored group was 91.2%, which was significantly higher than control groups (amoxicillin, rabeprazole, clarithromycin; 75.9% and amoxicillin, rabeprazole, metronidazole; 79.1%) [138] . Appropriate stomach acid suppression, as well as resistant strains of H. pylori, remains a problem for successful eradication.…”

Section: Is Tailored Therapy On the Horizon For H Pylori Treatment?mentioning

confidence: 83%

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Kim

Choi

Chung

2015

WJGPT

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Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori ) has been associated with gastroduodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Core tip: This article reviews the recent literature describing antibiotic resistance and trends in Helicobacter pylori (H. pylori ) treatment. As there is no effective conventional therapy, new treatments are being developed and bismuth quadruple, sequential, concomitant therapies are recommended as a first-line regimen in regions with high levels of clarithromycin resistance. Quinolones have also been used for H. pylori treatment, although the cure rate has gradually reduced with this approach. New therapeutic directions include probiotic supplementation, tailored therapy, novel agents, and nanotechnology.

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Section: Is Tailored Therapy On the Horizon For H Pylori Treatment?mentioning

confidence: 83%

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Kim

Choi

Chung

2015

WJGPT

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“…24 On the basis of the 13 C-urea breath test, H. pylori detection by DPO-PCR had a sensitivity of 87.5%, a specificity of 91.3%, a positive predictive value of 84.0%, a negative predictive value of 93.3%, and an accuracy of 90.0%. 6 In addition, DPO-PCR has a revolutionary peculiarity in providing information about clarithromycin resistance, a main predictor of failure of eradication treatment and has excellent correlation with E-test susceptibility. 21,23 DPO-PCR for the detection of H. pylori 23S rDNA mutations, involved in macrolide resistance was previously evaluated in several studies.…”

Section: Discussionmentioning

confidence: 99%

A Pilot Study ofHelicobacter pyloriEradication Using a Polymerase Chain Reaction-based Test for Clarithromycin Resistance

Jung

Kim

Chung

2017

Korean J Helicobacter Up Gastrointest Res

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Background/Aims: Clarithromycin resistance is one of the main predictors of eradication treatment failures in Helicobacter pylori infections. The aim of this study was to investigate the ideal eradication rate of more than 90% of tailored therapies using a polymerase chain reaction (PCR)-based test for clarithromycin resistance in patients with peptic ulcer disease. In addition, we evaluated the possibility of sequential therapies for infections due to clarithromycin-resistant strains. Materials and Methods: We prospectively enrolled patients referred to the gastroenterology unit for the evaluation and management of peptic ulcer from January 2012 to January 2014. Histology, a rapid urease test, and a dual-priming oligonucleotide-based multiplex (DPO)-PCR test were performed on gastric biopsy specimens. In the absence of 23S rRNA point mutations in H. pylori, the patients were treated with standard triple therapy, while in the presence of 23S rRNA point mutations, they were treated with sequential therapies. Results: A total of 93 patients had peptic ulcer disease that was associated with H. pylori infections. These patients received eradication therapies, and 78 patients completed the therapies. The total eradication rate was 91% per protocol analysis, whereas it was 78.3% in patients treated with sequential therapies. Conclusions: The eradication rate of H. pylori with tailored therapies using the DPO-PCR test was acceptable. However, sequential therapies were not effective in patients who did not respond to clarithromycin.

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“…Figure 1 details the procedure of study selection in the flow chart. Thirteen studies [13][14][15][16][17][18][19][20][21][22][23][24][25] were qualified in this meta-analysis. Tables 1 and 2 set 2 different control groups, respectively, which were labeled as group a and b in our study (e.g., Lee a and Lee b).…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Ten tailored regimens [14][15][16][17]19,[21][22][23][24][25] were designed according to pretreatment susceptibility testing (pooled RR ¼ 1.17, 95% CI 1.11-1.24). Three other studies 13,18,20 advanced their susceptibility-guided therapy by additionally adjusting their PPI administration (either by dosage adjustments or by changing drugs) on the basis of CYP2C19 polymorphism (pooled RR ¼ 1.14, 95% CI 1.01-1.28). The analytical results indicate that both types of tailored therapy are better than empirical treatments in achieving higher eradication rates ( Figure 4A).…”

Section: Types Of Tailored Regimensmentioning

confidence: 99%