Helicobacter pylori Resistance to Clarithromycin in the Russian Federation

Abstract

Purpose – the systematization of data on the resistance of Helicobacter pylori to clarithromycin in the Russian Federation. Material and methods. Necessary investigations were searched in the electronic databases MEDLINE/PubMed, EMBASE, Cochrane, and the Russian Science Citation Index (RSCI), published between January and September, 2020. The final analysis included original publications from periodically reviewed foreign and Russian publications, as well as dissertations that used validated H. pylori resistance assessment tests with detailed descriptive statistics that allow the resulting data to be included in the meta-analysis. Results. The final analysis included 16 studies (1227 isolates). The generalized indicator of H. pylori resistance to clarithromycin in the Russian Federation was 11.85% (95% confidence interval (CI) 7.315–17.302; I2 = 86.19%). When analyzing papers published over the past ten years, H. pylori resistance to clarithromycin was 10.39% (95% CI 7.103–14.219; I2 = 61.29%). In Moscow and the Moscow Region, the generalized indicator of H. pylori resistance to clarithromycin was 10.87% (95% CI 7,280–15,439; I2 = 50.57%), in St. Petersburg – 22.26% (95% CI 9,525–38,470; I2 = 84.75%), Smolensk – 5.74% (95% CI 3,511–8,789; I2 = 0.00%), Kazan – 10.0% (95% CI 5,023–17,355; I2 = 45.22%). Conclusion. The results show that the resistance of H. pylori to clarithromycin in Russia does not exceed the 15% threshold regulated by the Maastricht-V Consensus, which allows us to consider a triple regimen of anti-Helicobacter therapy with clarithromycin as a first-line therapy. At the same time, to achieve the maximum effect when using classical triple therapy and to level the risk of further progression of clarithromycin resistance of H. pylori in Russia, it is advisable to use methods of its optimization.

First insight into the whole-genome sequence variations in clarithromycin- resistant Helicobacter pylori clinical isolates in Russia

“…Thus, routine H. pylori susceptibility testing usually is not provided in clinical settings and empirical therapy can cause eradication failures and increasing resistance rate. According to the latest data (2020), the prevalence of clarithromycin resistance in Moscow reached 10.87%, Smolensk − 5.74%, Kazan − 10.0% and in St. Petersburg − 22.26% [29,30]. Such difference indicates the wide variation in resistance rates in Russia, highlighting the need to ongoing examination of CLR-resistance in each geographic region.…”

Treatment of <i>Helicobacter pylori</i> infection for medical professionals

“…Обобщенный показатель резистентности к кларитромицину в РФ составил 11,85% (95% ДИ 7,315-17,302; I 2 = 86,19%), в Москве и Московской области -10,87% (95% ДИ 7,280-15,439; I 2 = 50,57%), в Санкт-Петербурге -22,26% (95% ДИ 9,525-38,470; I 2 = 84,75%), в Смоленске -5,74% (95% ДИ 3,511-8,789; I 2 = 0,00%), в Казани -10,0% (95% ДИ 5,023-17,355; I 2 = 45,22%). Эти данные свидетельствуют о возможности использования режимов терапии на основе кларитромицина в РФ в качестве терапии первой линии с применением методов ее оптимизации [8]. В качестве таких методов рассматривается добавление солей висмута к антибактериальным препаратам, увеличение продолжительности лечения до 14 дней, использование в качестве ингибиторов протонной помпы (ИПП) рабепразола и эзомепразола в удвоенной дозе [9].…”

Combination of gastroprotectors and probiotics in the eradication of H. pylori infection: results of a randomized comparative clinical trial

“…Согласно мировым представ лениям, в регионах с резистентностью H. pylori к кла ритромицину менее 15% случаев в качестве схемы пер вой линии рекомендуется стандартная тройная терапия, которая включает в себя ингибитор протонной помпы (ИПП), кларитромицин и амоксициллин [6,7]. За послед нее время согласно опубликованным данным, в регионах РФ, за исключением СанктПетербурга, резистентность к кларитромицину не превышает 15% [8]. При этом эф фективность стандартной терапии в РФ не превышает 90% [9][10][11][12].…”