The effect of previous eradication failure on antibiotic resistance of Helicobacter pylori: A retrospective study over 8 years in Beijing

Abstract

Background: Antibiotic resistance is the main cause of Helicobacter pylori (H. pylori) treatment failure. This study aimed to explore the characteristics of antibiotic resistance of H. pylori isolates in Beijing in the last 8 years and to estimate the impact of previous eradication failure on resistance patterns. Materials and methods:This retrospective study included data from a single center in Beijing from 2013 to 2020. Antibiotic susceptibility of 365 clinical H. pylori isolates was tested for amoxicillin, clarithromycin, metronidazole, levofloxacin, moxifloxacin, and tetracycline. The characteristics of the included patients and their previous eradication history were collected. Primary and secondary resistance rates of H. pylori to the six antibiotics and the impact of previous eradication failure on antibiotic resistance patterns were analyzed. Results:The overall primary resistance rates of amoxicillin, clarithromycin, metronidazole, levofloxacin, moxifloxacin, and tetracycline were 0.7%, 55.2%, 68.0%, 49.7%, 64.5%, and 0%, with no significant increase during the observed period; while the secondary resistance rates were 3.2%, 96.7%, 90.7%, 93.1%, 80.0%, and 0%, respectively. The secondary resistance rate of clarithromycin (p < .001), metronidazole (p = .001), and levofloxacin (p < .001) significantly increased to 100% as the number of previous eradication therapies increased and exhibited a linear association. For strains naive to eradication, only 6.8% were susceptible to all the antibiotics, while 32.4% were single resistant, and 60.8% dual or multiple resistant. Clarithromycin+ metronidazole+fluoroquinolone multiple resistance was the predominant pattern (0 course: 21.6%, 1 course: 37.5%, 2 courses: 56.1%, ≥3 courses: 71.1%; p < .001) for patients with treatment failure. The prevalence of dual or multiple-resistance patterns increased significantly as the number of previous therapies increased. Conclusions:The prevalence of primary and secondary resistance rates of clarithromycin, metronidazole, moxifloxacin, and levofloxacin were high in Beijing. Multipleresistance patterns were common after treatment failure. Resistance rates of amoxicillin and tetracycline remained low and stable.

Alarming antibiotics resistance of Helicobacter pylori from children in Southeast China over 6 years

“…LEV is usually contraindicated in children younger than 18 years because of potential severe side effects, though it has been extensively studied in eradicating H. pylori and been proven to be effective in adults. The overall resistance rate of H. pylori to LEV also increased over time in our studies though it was lower than that in adults 27 . As H. pylori infection is usually acquired in childhood mainly through intra-family transmission, the high LEV resistance in children might be explained by the transmission of LEV-resistant strains from parents to children.…”

Eradication rate and safety of a “simplified rescue therapy”: 14‐day vonoprazan and amoxicillin dual regimen as rescue therapy on treatment of Helicobacter pylori infection previously failed in eradication: A real‐world, retrospective clinical study in China

“…Different from the other antibiotics, there is consistent reports that the primary and secondary resistance rates of H. pylori to amoxicillin maintained at a low level 3,4 5–7 .…”

“…Different from the other antibiotics, there is consistent reports that the primary and secondary resistance rates of H. pylori to amoxicillin maintained at a low level. 3,4 In recent years, protonpump inhibitor (PPI) plus amoxicillin dual therapy has gained increasing attention worldwide because of its effectiveness with a cure rate of 95.3% in first-line treatment and 89.3% in second-line treatment. [5][6][7] It is currently believed that the outcome of the dual therapy is pH-dependent.…”

Efficacy and safety of triple therapy containing berberine hydrochloride, amoxicillin, and rabeprazole in the eradication of Helicobacter pylori

“…An eradication rate below 80% using the triple therapy is no longer acceptable 10 . In China, the resistance rate of H. pylori to clarithromycin (20%–55.2%), metronidazole (40%–90.6%), and levofloxacin (20%–50%) is high, while that to amoxicillin (0%–7.7%), tetracycline (0%–5%), and furazolidone (0%–0.91%) remains low 30–32 . However, it is difficult to exert too much effect clinically due to numerous AEs, complicated administration, and nonavailability.…”