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Effect of ornidazole and clarithromycin resistance on eradication of Helicobacter pylori in peptic ulcer disease
Author(s) -
Frank Serge Lehmann,
Jürgen Drewe,
Luigi Terracciano,
C. Beglinger
Publication year - 2000
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.1365-2036.2000.00717.x
Subject(s) - clarithromycin , lansoprazole , medicine , metronidazole , helicobacter pylori , ornidazole , gastroenterology , antibiotics , urea breath test , microbiology and biotechnology , helicobacter pylori infection , biology
Background: Clarithromycin and nitroimidazoles such as metronidazole and ornidazole are among the most frequently used antibiotics for curing Helicobacter pylori infection. However, controversial data exist on whether their in vitro resistance has a negative impact on treatment outcome. Methods: Patients with H. pylori positive active peptic ulcer disease were randomly assigned to receive lansoprazole 30 mg o.d., amoxycillin 1 g b.d. and ornidazole 500 mg b.d. (LAO) or lansoprazole 30 mg o.d., amoxycillin 1 g b.d. and clarithromycin 500 mg b.d. (LAC) for 2 weeks. Pre‐treatment resistance to ornidazole and clarithromycin was assessed by Epsilometer (E‐) test. Four weeks after completion of treatment, patients underwent a 13 C urea breath test to assess H. pylori status. Results: Data from 80 patients with active peptic ulcer disease and positive H. pylori status were analysed. The prevalence of primary drug resistance was 25% for metronidazole and 7.5% for clarithromycin. In patients treated with LAO, effective treatment was achieved in 87% of metronidazole‐susceptible, but only 30% of metronidazole‐resistant strains ( P < 0.01). In the LAC group, therapy was successful in 81% of clarithromycin‐susceptible strains, whereas treatment failed in all patients with primary clarithromycin resistance ( n = 3). Conclusion: Resistance against nitroimidazoles significantly affects treatment outcome in H. pylori eradication therapy.