Incidence of secondary Helicobacter pylori resistance to antibiotics in treatment failures after 1-week proton pump inhibitor-based triple therapies: a prospective study

Pilotto, Alberto; Franceschi, Marilisa; Rassu, Mario; Leandro, Gioacchino; Bozzola, L.; Furlan, Francesca; Mario, F. Di

doi:10.1016/s1590-8658(00)80327-8

Cited by 58 publications

(53 citation statements)

References 22 publications

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“…En nuestro estudio se seleccionaron las biopsias obtenidas del fondo y antro gástrico como se recomienda (12), mientras que el cultivo se realizó dentro de las 2 horas para evitar la pérdida de la viabilidad de las cepas. Tanto la resistencia "primaria" asociada con el uso de antibióticos para el tratamiento de infecciones causadas por patógenos distintos a H. pylori, como la resistencia "secundaria" causada por un tratamiento previo con el fin de erradicar H. pylori influyen en su erradicación (13)(14)(15). El CLSI establece puntos de corte clínicos para la claritromicina, pero no lo hace para amoxicilina, tetraciclina, metronidazol y levofloxacina.…”

Section: Discussionunclassified

Susceptibilidad antibiótica de Helicobacter pylori: un estudio de prevalencia en pacientes con dispepsia en Quito-Ecuador

Reyes

Guzmán

Morales

et al. 2017

Rev. Colomb. Gastroenterol.

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Introducción: Helicobacter pylori se lo asocia a patologías gastro-intestinales, el incremento en la resistencia a los antibióticos utilizados para su erradicación es alarmante a nivel mundial. En este estudio se determinó la susceptibilidad a cinco antibióticos utilizados en la terapia de erradicación de H. pylori aislado de una población adulta con dispepsia recurrente en Quito-Ecuador.Materiales y métodos: Previa aceptación del consentimiento informado, se tomaron biopsias de cuerpo y fondo gástrico de 210 pacientes con dispepsia, mediante cultivo se recuperaron los aislados de H. pylori identificado mediante pruebas bioquímicas. La susceptibilidad al metronidazol, claritromicina, amoxicilina, tetraciclina y levofloxacina se realizó por concentración mínima inhibitoria (CMI). Todos los cultivos se correlacionaron con el estudio histopatológico.Resultados: Se recuperaron 89 aislados de H. pylori. Se obtuvo un kappa de 0.9 entre el cultivo y el estudio histopatológico. El porcentaje de cepas con resistencia antibiótica fue: metronidazol (63 %), claritromicina (66 %), amoxicilina (43%), tetraciclina (36%) y levofloxacina (54%).Conclusión: Estos hallazgos demuestran la alta resistencia a los antibióticos usados para la erradicación de H. pylori, varios factores como consumo indiscriminado de antibióticos, terapia previa, etc. podrían estar involucrados.Palabras clave: Helicobacter pylori; resistencia antibiótica; concentración mínima inhibitoria.

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Section: Discussionunclassified

Susceptibilidad antibiótica de Helicobacter pylori: un estudio de prevalencia en pacientes con dispepsia en Quito-Ecuador

Reyes

Guzmán

Morales

et al. 2017

Rev. Colomb. Gastroenterol.

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“…(8) When a repeat (rescue) therapy must be selected, we have several data that will aid us in suspecting resistance to a particular antibiotic, without the necessity of a culture, based on the observation that acquired bacterial resistance to metronidazole or clarithromycin results primarily from previous treatment failure [26,32] . Thus, when a therapy with clarithromycin fails, resistance to this antibiotic appears in most cases, and the same is true when a nitroimidazole is the antibiotic first used [18,29,131,142] . Even if resistance to these antibiotics does not appear, it remains uncertain whether their readministration is adequate, as they were not efficacious (for unknown reasons) for the first time.…”

Section: Is It Necessary To Performmentioning

confidence: 99%

“…Firstly, omeprazole plus amoxicillin, with a high dose of both the antibiotic and the antisecretor, could, in theory, be recommended [128,130] ; however, we must remember that this "old-fashioned" dual combination has achieved disappointing results in many countries. Therefore, a second antibiotic should be added, and at this point a difficult decision appears, as both antibiotics used in the first trial (clarithromycin and metronidazole) are capable of inducing secondary resistance to H pylori, playing a negative role in future efficacy [25][26][27][28][29]131] . Nevertheless, the following possibilities exist:…”

Section: Rbc Tetracycline and Metronidazolementioning

confidence: 99%

“Rescue” regimens after Helicobacter pylori treatment failure

Gisbert¹

2008

WJG

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Helicobacter pylori (H pylori ) infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. After more than 20 years of experience in H pylori treatment, in my opinion, the ideal regimen to treat this infection is still to be found. Currently, apart from having to know first-line eradication regimens well, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a "rescue" treatment depends on which treatment is used initially. If a clarithromycinbased regimen was used initially, a subsequent metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacinbased combination would be a third "rescue" option. Alternatively, it has recently been suggested that levofloxacin-based rescue therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, a quadruple regimen may be reserved as a third-line rescue option. Finally, rifabutin-based rescue therapy constitutes an encouraging empirical fourthline strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H pylori eradication can finally be achieved in almost all patients if several rescue therapies are consecutively given. Therefore, the attitude in H pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.

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“…Firstly, omeprazole plus amoxicillin, with a high dose of both the antibiotic and the antisecretor, could in theory be recommended [Miehlke et al 2006;Axon, 2000]; however, we must remember that this 'old-fashioned' dual combination has achieved disappointing results in many countries. Therefore, a second antibiotic should be added, and at this point a difficult decision appears, as both antibiotics used in the first trial (clarithromycin and metronidazole) are capable of inducing secondary resistance to H. pylori, playing a negative role in future efficacy [Saad and Chey, 2008;Dore et al 2000;Pilotto et al 2000;Houben et al 1999;Peitz et al 1999;Van Der Wouden et al 1999;Tompkins et al 1997]. Nevertheless, the following possibilities exist.…”

Section: Introductionmentioning

confidence: 99%

Review: Second-line rescue therapy of Helicobacter pylori infection

Gisbert

2009

Therap Adv Gastroenterol

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Helicobacter pylori infection is the main known cause of gastritis, gastroduodenal ulcer disease and gastric cancer. After more than 20 years of experience in H. pylori treatment, however, the ideal regimen to treat this infection has still to be found. Nowadays, apart from having to know well first-line eradication regimens, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a 'rescue' treatment depends on which treatment is used initially. If a first-line clarithromycin-based regimen was used, a second-line metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacin-based combination would be a third-line 'rescue' option. Alternatively, it has recently been suggested that levofloxacin-based 'rescue' therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, quadruple regimen may be reserved as a third-line 'rescue' option. Finally, rifabutin-based 'rescue' therapy constitutes an encouraging empirical fourth-line strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H. pylori eradication can finally be achieved in almost all patients if several 'rescue' therapies are consecutively given. Therefore, the attitude in H. pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.

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Incidence of secondary Helicobacter pylori resistance to antibiotics in treatment failures after 1-week proton pump inhibitor-based triple therapies: a prospective study

Cited by 58 publications

References 22 publications

Susceptibilidad antibiótica de Helicobacter pylori: un estudio de prevalencia en pacientes con dispepsia en Quito-Ecuador

Susceptibilidad antibiótica de Helicobacter pylori: un estudio de prevalencia en pacientes con dispepsia en Quito-Ecuador

“Rescue” regimens after Helicobacter pylori treatment failure

Review: Second-line rescue therapy of Helicobacter pylori infection

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