Helicobacter pylori antimicrobial resistance during a 5‐year period (2013‐2017) in northern Spain and its relationship with the eradication therapies

Abstract

Background Antibiotic resistance is the main cause for Helicobacter pylori therapy failure. Frequently, empirical regimens have been recommended in patients with various H. pylori eradication failures. In patients with H. pylori‐resistant to various families of antibiotics, the treatment guided by antimicrobial susceptibility testing allows the achievement of good eradication rates. Aim To evaluate the effectiveness of susceptibility‐guided antimicrobial treatment for H. pylori infection in patients with resistance to one or various families of antibiotics. Methods A total of 3170 consecutive patients infected by H. pylori during 2013‐2017 were tested for antimicrobial susceptibility. 66.6% patients showed resistance to one antimicrobial, 18.9% to two, and 2.4% to three families of antibiotics. A cohort of 162 H. pylori‐positive patients were enrolled in this study. Forty‐three with single H. pylori resistance to clarithromycin (CLR) were treated with omeprazole (PPI), amoxicillin (AMX), and levofloxacin (LVX)—OAL (31 subjects) or omeprazole, AMX, and metronidazole (MTZ)—OAM (12 patients) and 77 patients with dual H. pylori resistance (51 to CLR and MTZ, 12 to CLR plus LVX, and 14 to MTZ plus LVX) received OAL or OBTM (PPI, bismuth subcitrate, tetracycline, and MTZ), OAM, and OAC, respectively. Other 42 patients with triple H. pylori resistance (CLR, LVX, and MTZ) were treated with PPI, AMX, and rifabutin—OAR (18 subjects), PPI, AMX, and doxycycline—OAD (8), OADB (7), OBTM (6), and ODBR (3). All subjects received standard doses for 10 days. Eradication rate was confirmed by 13C‐UBT. Adverse events were assessed by a questionnaire. Results Intention‐to‐treat analysis demonstrates that eradication rates using triple therapies in patients with H. pylori resistance to one and to two families of antibiotics were 93% and 94.8%, respectively. In subjects with H. pylori‐resistant to three families of antibiotics, cure rate was higher in naïve patients treated with OAR‐10 days compared to those treated with bismuth‐containing quadruple therapies (90% vs 75%). Adverse events were limited (18 of 162, 11.1%), all of them mild‐moderate. Conclusions The implementation of susceptibility‐guided triple therapy for 10 days leads to eradication rate ≥95% in naïve patients with H. pylori resistance to one or two families of antimicrobials. In naïve patients with H. pylori resistance to three families, OAR treatment achieved a 90% of eradication.

Helicobacter pylori pathogenicity and primary antimicrobial resistance in Northern Spain

“…23 Results obtained from this work support that treatment failure is associated with higher resistance rate. 3,7,10 A recent study of our group showed that global resistance rate, including antimicrobial susceptibility data from naïve and patients after treatment failure, in the period 2013-2017 was 17.9% for CLA, 19.3% for LV and 30.7% for MZ.…”

“…3,7,10 A recent study of our group showed that global resistance rate, including antimicrobial susceptibility data from naïve and patients after treatment failure, in the period 2013-2017 was 17.9% for CLA, 19.3% for LV and 30.7% for MZ. 23 Results obtained from this work support that treatment failure is associated with higher resistance rate. Primary CLA-R was 12.1%, lower than published data in Spain, which ranged from 14.7% up to 35.6% 3,24-26 and in Europe from 17.5% to 22.2%.…”

Rifabutin triple therapy for first‐line and rescue treatment of Helicobacter pylori infection: A systematic review and meta‐analysis

“…Eleven studies (including 18 substudies) compared rifabutin triple therapy with another treatment protocol 11,17,21,22,24,30,37,39,41,45,47 . The control group received bismuth quadruple therapy in 6/12 (50.0%) studies (pooled eradication success, 147/221 [66.5%] vs 125/188 [66.4%] in rifabutin vs control, respectively, P = 1.0).…”

Rifabutin for the Treatment of Helicobacter pylori Infection: A Review

“…Accordingly, the efficacy of rifabutin treatment was not significantly influenced by the number of previous treatment failures in a recent study: eradication rates in patients with one, two, three, and four or more previous failures were 78.3%, 89.6%, 68.6%, and 88.9%, respectively (non-statistically significant differences) [47]. Just a few studies have directly compared-that is, in the same protocol of H. pylori eradication-rifabutin vs. other antibiotics [36,51,86,87,91,104]. Firstly, few studies have compared a PPI, amoxicillin, and rifabutin triple combination with the commonly used bismuth-containing quadruple regimen.…”

“…On intention-to-treat analysis, eradication rates were 87% for rifabutin-containing therapy and 67% for bismuth quadruple therapy (these differences being statistically significant). More recent studies have shown better results with the rifabutin-triple [87] or bismuth-quadruple [91,104,108] regimen. Finally, the rifabutin-levofloxacin regimen has also been compared with the bismuth quadruple treatment for second-line treatment, reporting similar high eradication rates (91%) and similar good compliance (>95%) [86].…”