L Fischbach1, E L Evans. 1. University of North Texas Health Science Center, School of Public Health, Fort Worth, TX 76107, USA. lfischba@hsc.unt.edu
Abstract
BACKGROUND: Information regarding the effects of drug resistance on therapies for Helicobacter pylori is limited. AIMS: To determine the effect of drug resistance on the efficacy of first-line treatment regimens for H. pylori and identify the most efficacious treatments in the presence of drug resistance. METHODS: We searched for studies using the keywords: 'Helicobacter pylori','resistance' and 'treatment' or 'therapy'. Multilevel meta-regression models were used to determine the effect of drug resistance on treatment efficacy. RESULTS: We analysed data from 93 studies with 10,178 participants. For triple therapies, clarithromycin resistance had a greater effect on treatment efficacy than nitroimidazole resistance. Metronidazole resistance reduced efficacy by 26% in triple therapies containing a nitroimidazole, tetracycline and bismuth, while efficacy was reduced by only 14% when a gastric acid inhibitor was added to the regimen. Quadruple therapies containing both clarithromycin and metronidazole were the most efficacious; >80% of H. pylori infections were consistently eradicated with these regimens. CONCLUSIONS: Drug resistance was a strong predictor of efficacy across triple therapies for the eradication of H. pylori in adults. Resistance to either clarithromycin or metronidazole, but not both simultaneously, may be overcome by using quadruple therapies, especially those containing both clarithromycin and metronidazole.
BACKGROUND: Information regarding the effects of drug resistance on therapies for Helicobacter pylori is limited. AIMS: To determine the effect of drug resistance on the efficacy of first-line treatment regimens for H. pylori and identify the most efficacious treatments in the presence of drug resistance. METHODS: We searched for studies using the keywords: 'Helicobacter pylori','resistance' and 'treatment' or 'therapy'. Multilevel meta-regression models were used to determine the effect of drug resistance on treatment efficacy. RESULTS: We analysed data from 93 studies with 10,178 participants. For triple therapies, clarithromycin resistance had a greater effect on treatment efficacy than nitroimidazole resistance. Metronidazole resistance reduced efficacy by 26% in triple therapies containing a nitroimidazole, tetracycline and bismuth, while efficacy was reduced by only 14% when a gastric acid inhibitor was added to the regimen. Quadruple therapies containing both clarithromycin and metronidazole were the most efficacious; >80% of H. pyloriinfections were consistently eradicated with these regimens. CONCLUSIONS: Drug resistance was a strong predictor of efficacy across triple therapies for the eradication of H. pylori in adults. Resistance to either clarithromycin or metronidazole, but not both simultaneously, may be overcome by using quadruple therapies, especially those containing both clarithromycin and metronidazole.
Authors: Antonio Rollan; Juan Pablo Arab; M Constanza Camargo; Roberto Candia; Paul Harris; Catterina Ferreccio; Charles S Rabkin; Juan Cristóbal Gana; Pablo Cortés; Rolando Herrero; Luisa Durán; Apolinaria García; Claudio Toledo; Alberto Espino; Nicole Lustig; Alberto Sarfatis; Catalina Figueroa; Javier Torres; Arnoldo Riquelme Journal: World J Gastroenterol Date: 2014-08-21 Impact factor: 5.742
Authors: Boudewijn L M de Jonge; Amy Kutschke; Joseph V Newman; Michael T Rooney; Wei Yang; Christer Cederberg Journal: Antimicrob Agents Chemother Date: 2015-02-02 Impact factor: 5.191
Authors: M Constanza Camargo; Apolinaria García; Arnoldo Riquelme; William Otero; Claudia A Camargo; Tomas Hernandez-García; Roberto Candia; Michael G Bruce; Charles S Rabkin Journal: Am J Gastroenterol Date: 2014-03-04 Impact factor: 10.864
Authors: Tran T Binh; Seiji Shiota; Lam T Nguyen; Dung D Q Ho; Hai H Hoang; Long Ta; Dung T Trinh; Toshio Fujioka; Yoshio Yamaoka Journal: J Clin Gastroenterol Date: 2013-03 Impact factor: 3.062