Primary antibiotic resistance of Helicobacter pylori in Chinese patients: a multiregion prospective 7-year study

Li, Dongsheng; Wang, Youhua; Zeng, Zhirong; Zhang, Zhenyu; Lü, Hong; Xu, Jianming; Du, Yiqi; Li, Yan; Wang, Jiangbin; Xu, Shuo; Chen, Ye; Lan, Chun‐Hui; Cheng, Hong; Jiang, Ming‐De; Zhang, Lingxia; Huo, Lijuan; Chen, Shiyao; Zhang, Guoxin; Wu, Kaichun; Zhu, Xuan; Chen, Youxiang; Zhu, Yin; Shu, Xu; Xie, Yong; Lü, Nonghua

doi:10.1016/j.cmi.2017.11.010

Cited by 79 publications

(90 citation statements)

References 8 publications

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“…H pylori resistance rates to some antibiotics are increasing but may have certain regional differences. Currently, the primary resistance rate to clarithromycin is 20%‐50%, to metronidazole is 40%‐70%, and to levofloxacin is 20%‐50%, while to amoxicillin (0%‐5%), tetracycline (0%‐5%), and furazolidone (0%‐1%) remain low in China . The clarithromycin‐containing triple regimen was recommended as a first‐line treatment therapy because of its high efficacy, reduced in taking of drugs, and marginal side effects.…”

Section: Discussionmentioning

confidence: 99%

Management of Helicobacter pylori infection by clinicians: A nationwide survey in a developing country

et al. 2019

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Background & Aims Developing countries are making efforts to improve health management. Practice deviating from the guideline means inefficient control. The study aims to investigate the management of Helicobacter pylori (H pylori) infection from a developing country perspective. Methods An authoritative survey was conducted in 14th (2014) and 17th (2017) Congress of Gastroenterology China, respectively. The Maastricht V/Florence consensus report was invoked as the evaluation criterion. Results A total of 4182 valid samples were included in this study. Most of the respondents (94%) updated knowledge by lectures. Respondents had a different awareness rate of H pylori‐related diseases, ranging from 45% to 95%. Up to 40% of the respondents did not follow the recommendations for the diagnosis. Choice accuracy of eradication regimens and antibiotic combinations was <70%. About 20% of the respondents did not pay attention to the confirmation after the eradication. The situation had been improved in 2017 when compared with that in 2014 (all P < .05). Multivariate logistic regression analysis revealed that influencing factors including nongastroenterologists, bachelor degree and below, the primary professional title, hospital location, and a small proportion of H pylori infection in daily practice related to the deviation of consensus (all P < .05). Conclusions Although the management of H pylori infection has been improved in a developing country, there is still a gap between the real‐world practices and the consensus. Influencing factors should be taken into account in decision‐making, and the corresponding population should be strengthened with precision training during the promotion of the guideline.

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Section: Discussionmentioning

confidence: 99%

Management of Helicobacter pylori infection by clinicians: A nationwide survey in a developing country

et al. 2019

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“…In China, clarithromycin resistance was increased rapidly, and now, the prevalence was 20%-40%. 31 Many researches showed that clarithromycin-resistant strains could affect the efficacy of tripletherapy regimen badly. 25,32 However, in quadruple therapy, it seems controversial.…”

Section: Discussionmentioning

confidence: 99%

Half‐dose clarithromycin‐containing bismuth quadruple therapy is effective and economical in treating Helicobacter pylori infection: A single‐center, open‐label, randomized trial

Wang

et al. 2019

Helicobacter

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Background Clarithromycin‐containing bismuth quadruple therapy has been recommended as the first‐line therapy for H pylori infection in China. However, its expensive cost and high antibiotic‐related adverse reactions are always haunting us. To find a safer, more cost‐effective, and high eradicative strategy for Helicobacter treatment, we investigated the efficacy of 14‐day bismuth quadruple therapy and different doses of clarithromycin in the first‐line treatment. Method A total of 210 patients with H pylori infection were recruited and randomly assigned to half‐dose clarithromycin group (esomeprazole 20 mg bid, amoxicillin 1 g bid, clarithromycin 250 mg bid, and bismuth potassium citrate 0.6 g bid) for 14 days or standard‐dose clarithromycin group (esomeprazole 20 mg bid, amoxicillin 1 g bid, clarithromycin 500 mg bid, and bismuth potassium citrate 0.6 g bid) for 14 days. A 13C‐urea breath test (13C‐UBT) was performed at least 4 weeks after treatment. The eradication rate of H pylori, the incidence of side effects, and the cost‐effectiveness of regimens were evaluated in this study. Results The eradication frequencies were 86.67% for both groups in the intention‐to‐treat analysis, while the per‐protocol eradication rates were 91% vs. 91.92% (p=0.817). The incidence of adverse events was higher in standard dose group (54.21% vs. 34.29%; p=0.004), especially bitter taste symptom. There was a higher level of costs per person associated with the standard‐dose group as compared with half‐dose group (￥804.3 vs ￥654.36). The cost‐effectiveness ratio of the half dose was less than that of the standard dose (7.55 vs 9.16 CNY per percent). Conclusions A 14‐day half‐dose clarithromycin‐containing bismuth quadruple regimen is as effective as the standard bismuth quadruple therapy at eradicating H pylori, which is better tolerated and more economical. (ChiCTR‐ROC‐15007406).

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“…The clinical applicability of RADB may be questionable due to the absence of a preliminary susceptibility test. Although the resistance rates of H. pylori to amoxicillin (0.1%‐4.4%), tetracycline (1.9%‐7.3%), and doxycycline (9.2%) were low in China, leading to a low probability of a strain resistant to amoxicillin or doxycycline in the included patients, data about antibiotic resistance could add further confidence. Unfortunately, due to cost‐effectiveness and patient intentions, the test for antibiotic susceptibility was absent in our study.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,4,5 The resistance rates of H. pylori to clarithromycin (21.5%-52.6%), metronidazole (63.4%-95.4%), and levofloxacin (19.2%-54.8%) are high, while the resistance rates to amoxicillin (0.1%-4.4%) and tetracycline (1.9%-7.3%) remain low in China. [7][8][9] This indicates that the combination of amoxicillin and tetracycline might be an ideal selection. In clinical practice, the efficacy of H. pylori eradication regimens containing amoxicillin and tetracycline may not be inferior to other regimens, 10 but the general unavailability and complicated administration procedure of tetracycline have restricted its clinical application.…”

mentioning

confidence: 99%

Bismuth, rabeprazole, amoxicillin, and doxycycline as first‐line Helicobacter pylori therapy in clinical practice: A pilot study

Chen

et al. 2019

Helicobacter

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Background Bismuth‐containing quadruple therapy (BQT) is a recommended alternative first‐line therapy for Helicobacter pylori (H. pylori) infection. We aim to evaluate the efficacy and safety of a new BQT with amoxicillin and doxycycline as a first‐line treatment for H. pylori infection in clinical practice. Methods An open, prospective pilot clinical study including H. pylori‐positive outpatients who had never received eradication treatment was carried out. An RADB regimen (10 mg rabeprazole, 1000 mg amoxicillin, 100 mg doxycycline, and 220 mg colloidal bismuth tartrate, all given bid for 14 days) was prescribed by gastroenterologists. H. pylori eradication was confirmed by a 13C‐urea breath test performed at least 6 weeks after the end of treatment. Regimen efficacy was evaluated by per‐protocol (PP) and intention‐to‐treat (ITT) analyses. Results One hundred eighteen patients were included in the study. The eradication rate of RADB was 93.8% (105/112; 95% CI 89.2%‐98.3%) in PP analysis and 89.8% (106/118; 95% CI 84.3%‐95.4%) in ITT analysis. The patient compliance rate was 97.5% (115/118). The adverse event rate was 6.8% (8/118). Adverse events included asthenia, loss of appetite, dry mouth, heartburn, diarrhea, and abdominal pain. All adverse events disappeared after completion of therapy. Conclusion Our results suggest that 14‐day BQT with amoxicillin and doxycycline can be an effective and safe eradication regimen for first‐line therapy against H. pylori infection in clinical practice.

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Primary antibiotic resistance of Helicobacter pylori in Chinese patients: a multiregion prospective 7-year study

Abstract: The resistance rates to metronidazole, CLA and LEV were high in China. Patient age, gender, disease and location were associated with the resistance of H. pylori to some antibiotics. Furazolidone, AMO and tetracycline are better choices for H. pylori treatment in China.

Cited by 79 publications

References 8 publications

Management of Helicobacter pylori infection by clinicians: A nationwide survey in a developing country

Management of Helicobacter pylori infection by clinicians: A nationwide survey in a developing country

Half‐dose clarithromycin‐containing bismuth quadruple therapy is effective and economical in treating Helicobacter pylori infection: A single‐center, open‐label, randomized trial

Bismuth, rabeprazole, amoxicillin, and doxycycline as first‐line Helicobacter pylori therapy in clinical practice: A pilot study

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