The Primary Resistance of Helicobacter pylori in Taiwan after the National Policy to Restrict Antibiotic Consumption and Its Relation to Virulence Factors—A Nationwide Study

Abstract

ObjectiveThe Taiwan Government issued a policy to restrict antimicrobial usage since 2001. We aimed to assess the changes in the antibiotic consumption and the primary resistance of H. pylori after this policy and the impact of virulence factors on resistance.MethodsThe defined daily dose (DDD) of antibiotics was analyzed using the Taiwan National Health Insurance (NHI) research database. H. pylori strains isolated from treatment naïve (N=1395) and failure from prior eradication therapies (N=360) from 9 hospitals between 2000 and 2012 were used for analysis. The minimum inhibitory concentration was determined by agar dilution test. Genotyping for CagA and VacA was determined by PCR method.ResultsThe DDD per 1000 persons per day of macrolides reduced from 1.12 in 1997 to 0.19 in 2008, whereas that of fluoroquinolones increased from 0.12 in 1997 to 0.35 in 2008. The primary resistance of amoxicillin, clarithromycin, metronidazole, and tetracycline remained as low as 2.2%, 7.9%, 23.7%, and 1.9% respectively. However, the primary levofloxacin resistance rose from 4.9% in 2000–2007 to 8.3% in 2008–2010 and 13.4% in 2011–2012 (p=0.001). The primary resistance of metronidazole was higher in females than males (33.1% vs. 18.8%, p<0.001), which was probably attributed to the higher consumption of nitroimidazole. Neither CagA nor VacA was associated with antibiotic resistance.ConclusionsThe low primary clarithromycin and metronidazole resistance of H. pylori in Taiwan might be attributed to the reduced consumption of macrolides and nitroimidazole after the national policy to restrict antimicrobial usage. Yet, further strategies are needed to restrict the consumption of fluoroquinolones in the face of rising levofloxacin resistance.

Expressions of the CagA protein and CagA-signaling molecules predict Helicobacter pylori dependence of early-stage gastric DLBCL

“…[54][55][56] When examining the prevalence of CagA-positive HP infection, the rate is ;60% in Western countries while similar studies in Eastern Asian populations suggest that it is nearly 90%. [57][58][59][60][61] Another interesting observation reported in our previous 28 and current studies is that CagA expression is more frequent in HP-dependent cases than in HP-independent cases, and that time to response to HPE is shorter in cases that express CagA. These findings are in line with the fact that Asian gastric MALT lymphoma patients have a higher response rate to HPE than Western patients (84.1% vs 73.8%; P 5 .0001).…”

“…63 Peng et al also reported that the frequency of CagA-positive strains of HP was significantly higher (P , .05) in patients with gastric DLBCL (MALT) than in those with gastric MALT lymphomas or gastritis. 64 Using polymerase chain reaction analysis (supplemental Methods), 60,61 we found that all 11 HP strains isolated from patients with HP-dependent gastric lymphomas (5 gastric DLBCLs and 6 gastric MALT lymphomas) are cagA gene positive (data not sown). In addition to the distinct prevalence of CagA-positive HP infection in Asian populations, East Asian CagA carries a EPIYA-D segment, which differs from the EPIYA-C motif commonly seen in Western CagA variants.…”

Prevalence of Primary Antimicrobial Resistance of H. pylori in Turkey: A Systematic Review

“…Changes in resistance profile over time may be caused by increased clarithromycin usage for pneumonia and decreased metronidazole usage for diarrhea because of a gradual increase in hygienic conditions nationwide [30]. Therefore, the prevention of unnecessary macrolide consumption may decrease the development of clarithromycin resistance [52,53]. In Japan, clarithromycin consumption increased fourfold between 1993 and 2000, which resulted in a fourfold increase in clarithromycin resistance [51].…”

Twelve-day quintuple regime containing four antibiotics as a rescue therapy for Helicobacter pylori eradication in the central region of Portugal

“…Another strategy to improve the efficacy of currently used regimens could be the implementation of a national program to restrict antibiotic consumption, especially macrolides and nitroimidazoles. In Taiwan, this policy has probably contributed to a low primary clarithromycin and metronidazole resistance of H. pylori (23).…”