Mei-Jyh Chen1,2, Ming-Shiang Wu1, Chien-Chuan Chen1, Chieh-Chang Chen1, Yu-Jen Fang3, Ming-Jong Bair4,5, Chi-Yang Chang6, Ji-Yuh Lee3, Wen-Feng Hsu7, Jiing-Chyuan Luo8, Jaw-Town Lin1,9, Jyh-Ming Liou1. 1. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. 2. Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. 3. Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, National Taiwan University College of Medicine, Yun-Lin, Taiwan. 4. Department of Nursing, Meiho University, Pingtung, Taiwan. 5. Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung, Taiwan. 6. Department of Internal Medicine, E-DA Hospital and I-Shou University, Kaohsiung County, Taiwan. 7. Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan. 8. Department of Medicine, National Yang-Ming University, School of Medicine, and Taipei Veterans General Hospital, Taipei, Taiwan. 9. Department of Internal Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
Abstract
BACKGROUND: The impact of amoxicillin resistance on the efficacy of regimens containing amoxicillin for Helicobacter pylori eradication remains unknown. OBJECTIVES: To investigate whether the efficacy of an amoxicillin-containing regimen is affected by amoxicillin resistance and to identify the optimal breakpoint for amoxicillin resistance. METHODS: This was a pooled analysis of five randomized trials conducted in Taiwan from 2007 to 2016. Patients who received amoxicillin-containing regimens were recruited. MICs were determined by agar dilution testing. Meta-analysis was performed to assess the risk ratio of eradication failure in amoxicillin-resistant strains compared with susceptible strains of seven different regimens. We performed further the pooled analysis and logistic regression in patients treated with clarithromycin triple therapy to identify the optimal breakpoint for amoxicillin resistance. RESULTS: A total of 2339 patients with available amoxicillin MICs were enrolled. Meta-analysis showed that the presence of amoxicillin resistance was consistently associated with increased risk of treatment failure of amoxicillin-containing regimens at different breakpoints (risk ratio: 1.41, 95% CI 1.12-1.78, P = 0.004 when the cut-off was 0.5 mg/L). The heterogeneity was low (I2 = 0%, P = 0.615). Pooled analysis also showed that amoxicillin resistance was an independent risk factor for treatment failure of clarithromycin triple therapy at different breakpoints. The best correlation was observed when the breakpoint of amoxicillin resistance was ≥0.125 mg/L (kappa coefficient 0.298), at which the resistance rate was 11.1% (110 of 990). CONCLUSIONS: The efficacies of amoxicillin-containing regimens are affected by amoxicillin resistance and the optimal breakpoint MIC is ≥ 0.125 mg/L.
BACKGROUND: The impact of amoxicillin resistance on the efficacy of regimens containing amoxicillin for Helicobacter pylori eradication remains unknown. OBJECTIVES: To investigate whether the efficacy of an amoxicillin-containing regimen is affected by amoxicillin resistance and to identify the optimal breakpoint for amoxicillin resistance. METHODS: This was a pooled analysis of five randomized trials conducted in Taiwan from 2007 to 2016. Patients who received amoxicillin-containing regimens were recruited. MICs were determined by agar dilution testing. Meta-analysis was performed to assess the risk ratio of eradication failure in amoxicillin-resistant strains compared with susceptible strains of seven different regimens. We performed further the pooled analysis and logistic regression in patients treated with clarithromycin triple therapy to identify the optimal breakpoint for amoxicillin resistance. RESULTS: A total of 2339 patients with available amoxicillin MICs were enrolled. Meta-analysis showed that the presence of amoxicillin resistance was consistently associated with increased risk of treatment failure of amoxicillin-containing regimens at different breakpoints (risk ratio: 1.41, 95% CI 1.12-1.78, P = 0.004 when the cut-off was 0.5 mg/L). The heterogeneity was low (I2 = 0%, P = 0.615). Pooled analysis also showed that amoxicillin resistance was an independent risk factor for treatment failure of clarithromycin triple therapy at different breakpoints. The best correlation was observed when the breakpoint of amoxicillin resistance was ≥0.125 mg/L (kappa coefficient 0.298), at which the resistance rate was 11.1% (110 of 990). CONCLUSIONS: The efficacies of amoxicillin-containing regimens are affected by amoxicillin resistance and the optimal breakpoint MIC is ≥ 0.125 mg/L.
Authors: Amir Hossein Miri; Mojtaba Kamankesh; Antoni Llopis-Lorente; Chenguang Liu; Matthias G Wacker; Ismaeil Haririan; Hamid Asadzadeh Aghdaei; Michael R Hamblin; Abbas Yadegar; Mazda Rad-Malekshahi; Mohammad Reza Zali Journal: Front Pharmacol Date: 2022-06-27 Impact factor: 5.988
Authors: Kristina G Hulten; Robert M Genta; Ira N Kalfus; Yi Zhou; Hongjun Zhang; David Y Graham Journal: Gastroenterology Date: 2021-07-19 Impact factor: 33.883