Our purpose was to define the effect of pretreatment Helicobacter pylori resistance to metronidazole or to clarithromycin on the success of antimicrobial therapy. We used 75 key words to perform a literature search in MEDLINE as well as manual searches to identify clinical treatment trials that provided results in relation to H. pylori susceptibility to metronidazole and clarithromycin or both during the period 1984-1997 (abstracts were not included). Meta-analysis was done with both fixed- and random-effect models; results were shown using Galbraith's radial plots. We identified 49 papers with 65 arms for metronidazole (3594 patients, 2434 harboring H. pylori strains sensitive to metronidazole and 1160 harboring resistant strains). Metronidazole resistance reduced effectiveness by an average of 37.7% (95% CI = 29.6-45.7%). The variability in the risk difference for metronidazole was 122.0 to -90.6 and the chi-square value for heterogeneity was significant (P<0.001). Susceptibility tests for clarithromycin were performed in 12 studies (501 patients, 468 harboring H. pylori strains sensitive to clarithromycin and 33 harboring resistant strains). Clarithromycin resistance reduced effectiveness by an average of 55% (95% CI = 33-78%). We found no common factors that allowed patients to be divided into subgroups with additional factors significantly associated with resistance. In conclusion, metronidazole or clarithromycin pretreatment resistant H. pylori are the main factors responsible for treatment failure with regimens using these compounds. If H. pylori antibiotic resistance continues to increase, pretherapy antibiotic sensitivity testing might become necessary in many regions.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1023/a:1005457226341 | DOI Listing |
Infect Dis Now
January 2025
CHU Poitiers, Department of Infectious Agents, Bacteriology Department, Poitiers, France; University of Poitiers, U1070 INSERM Pharmacology of Antimicrobial Agents and Antibiotic Resistance, Poitiers, France.
Introduction: The increasing resistance of Helicobacter pylori to clarithromycin leads to an ongoing adaptation of empirical first-line treatment for H. pylori infections.
Patients And Methods: Prospective study (2022-2023) of 364 patients with no previous treatment for H.
Pharmacoepidemiology
March 2024
Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine Houston, 2002 Holcombe Blvd (111D), Houston, TX 77030, USA.
is a class I carcinogen that infects more than 100 million individuals in the United States. Antimicrobial therapy for has typically been prescribed empirically rather than based on susceptibility testing. Until recently, therapeutic recommendations have generally ignored the principles of antibiotic stewardship.
View Article and Find Full Text PDFJ Clin Med
December 2024
Department of Internal Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea.
Bismuth quadruple therapy (BQT) is recommended as the best second-line regimen after failure of first-line clarithromycin triple therapy (CTT) for eradication. However, there are some limitations to this approach, including the lack of an appropriate sequel regimen after failure of BQT and complicated administration. Metronidazole triple therapy (MTT) is simple to administer, but it is not widely recommended.
View Article and Find Full Text PDFFront Cell Infect Microbiol
January 2025
Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China.
is increasingly resistant to antibiotics, significantly lowering eradication rates and posing a major public health challenge. This study investigated the distribution of antibiotic-resistant phenotypes and genotypes of in Hainan Province. It determined the minimum inhibitory concentrations (MICs) of six antibiotics using the E-test method and detected resistance genes via Sanger sequencing.
View Article and Find Full Text PDFJ Gastrointestin Liver Dis
December 2024
Department of Medical and Surgical Sciences, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna; Department of Cardiovascular Medicine Unit, Heart, Chest and Vascular, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Background And Aims: Bacterial resistance toward the most used antibiotics is increasing in Helicobacter pylori (H. pylori) strains worldwide. The emergence of multidrug resistance significantly affects the efficacy of standard therapy regimens.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!