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The effect of antibiotic resistance on the outcome of three 1‐week triple therapies against Helicobacter pylori
Author(s) -
Alberto Pilotto,
Gioacchino Leandro,
Marilisa Franceschi,
Mario Rassu,
L. Bozzola,
Francesca Furlan,
Francesco Di Mario,
G. Valerio
Publication year - 1999
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.1999.00508.x
Subject(s) - clarithromycin , metronidazole , medicine , pantoprazole , helicobacter pylori , gastroenterology , rapid urease test , antibiotics , amoxicillin , antibacterial agent , microbiology and biotechnology , gastritis , omeprazole , biology
Background : Resistance of Helicobacter pylori to antibiotics may be a major reason for treatment failure. Aim : To evaluate the effect of primary H. pylori resistance to antibiotics on the cure rates of three anti‐ H. pylori 1‐week triple therapies. Methods : One hundred and sixteen consecutive patients diagnosed H. pylori ‐positive by gastric histology, rapid urease test and culture were enrolled. Activity of tested antibiotics was determined by means of the E ‐test. Patients were treated for 7 days with: (i) pantoprazole 40 mg o.d. plus amoxycillin 1 g b.d. and metronidazole 250 mg q.d.s. (PAM); (ii) pantoprazole 40 mg o.d. plus clarithromycin 250 mg b.d. and metronidazole 250 mg q.d.s. (PCM); or (iii) pantoprazole 40 mg o.d. plus amoxycillin 1 g b.d. and clarithromycin 250 mg b.d. (PAC). Two months after completion of therapy, endoscopy and gastric biopsies were repeated. Results : Primary resistance rates to metronidazole, clarithromycin and amoxycillin were 17.2, 6.9 and 0%, respectively. Overall H. pylori cure rates expressed as intention‐to‐treat and per protocol analyses were, respectively, 79% and 86% with PAM, 82% and 89% with PCM , and 85% and 85% with PAC. Significantly lower cure rates were observed in metronidazole‐resistant patients treated with PAM (56% vs. 96%, P = 0.01) or PCM (50% vs. 97%, P = 0.01). A trend towards lower H. pylori cure rates was observed in clarithromycin‐resistant patients treated with PCM (67% vs. 91%, P = 0.74) or PAC (50% vs. 87%, P = 0.68). Conclusion : Primary resistance to metronidazole influences the H. pylori cure rate of anti‐ H. pylori proton pump inhibitor‐based triple therapies which include this antibiotic. A similar trend exists for primary clarithromycin resistance.