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Resistance to metronidazole, clarithromycin and levofloxacin of Helicobacter pylori before and after clarithromycin‐based therapy in Taiwan
Author(s) -
Chang WeiLun,
Sheu BorShyang,
Cheng HsiuChi,
Yang YaoJong,
Yang HsiaoBai,
Wu JiunnJong
Publication year - 2009
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2009.05829.x
Subject(s) - clarithromycin , levofloxacin , medicine , metronidazole , helicobacter pylori , helicobacter infections , antibacterial agent , microbiology and biotechnology , gastroenterology , antibiotics , biology
Background and Aim: Clarithromycin‐based triple therapy has been commonly applied as the first‐line therapy for Helicobacter pylori eradication. Levofloxacin could serve as an alternative in either first‐line or second‐line regimens. This study surveyed the prevalence of levofloxacin resistance of H. pylori isolates in naive patients and in patients with a failed clarithromycin‐based triple therapy. Methods: The study collected the H. pylori isolates from 180 naive patients and 47 patients with a failed clarithromycin‐based triple therapy. Their in vitro antimicrobial resistance was determined by E ‐test. Results: The naive H. pylori isolates had resistance rates for amoxicillin, levofloxacin, clarithromycin and metronidazole of 0%, 9.4%, 10.6% and 26.7%, respectively. An evolutional increase of the primary levofloxacin resistance was observed in isolates collected after 2004, as compared to isolates collected before 2004 (16.3% vs 3.2%, P = 0.003). There was no evolutional increment of the primary clarithromycin resistance. The clarithromycin resistance elevated significantly after a failed clarithromycin‐based triple therapy (78.7% vs 10.6%, P < 0.001). The post‐treatment isolates remained to have a levofloxacin resistance rate of near 17%, but the levofloxacin‐resistant isolates were correlated with a higher incidence of metronidazole resistance ( P = 0.023). No strain was found to be resistant to amoxicillin even after eradication failure. Conclusion: The levofloxacin resistance of naive H. pylori remains less than 10% in Taiwan. With relatively lower resistance to levofloxacin than to metronidazole of the H. pylori isolates collected after a failed clarithromycin‐based therapy, proton pump inhibitor–levofloxacin–amoxicillin may be an alternative choice to serve as the second‐line therapy.