The effect of antibiotic resistance on the outcome of three 1-week triple therapies against Helicobacter pylori

A. Pilotto, G. Leandro, M. Franceschi, M. Rassu, L. Bozzola, F. Furlan, F. Di Mario, G. Valerio

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)667-673
Number of pages7
JournalAlimentary Pharmacology and Therapeutics
Volume13
Issue number5
DOIs
Publication statusPublished - 1999

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Microbial Drug Resistance
Helicobacter pylori
Clarithromycin
Metronidazole
Amoxicillin
Therapeutics
Anti-Bacterial Agents
Stomach
Urease
Proton Pump Inhibitors
Treatment Failure
Endoscopy
Histology
Biopsy
pantoprazole

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

The effect of antibiotic resistance on the outcome of three 1-week triple therapies against Helicobacter pylori. / Pilotto, A.; Leandro, G.; Franceschi, M.; Rassu, M.; Bozzola, L.; Furlan, F.; Di Mario, F.; Valerio, G.

In: Alimentary Pharmacology and Therapeutics, Vol. 13, No. 5, 1999, p. 667-673.

Research output: Contribution to journalArticle

Pilotto, A. ; Leandro, G. ; Franceschi, M. ; Rassu, M. ; Bozzola, L. ; Furlan, F. ; Di Mario, F. ; Valerio, G. / The effect of antibiotic resistance on the outcome of three 1-week triple therapies against Helicobacter pylori. In: Alimentary Pharmacology and Therapeutics. 1999 ; Vol. 13, No. 5. pp. 667-673.
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abstract = "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.",
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T1 - The effect of antibiotic resistance on the outcome of three 1-week triple therapies against Helicobacter pylori

AU - Pilotto, A.

AU - Leandro, G.

AU - Franceschi, M.

AU - Rassu, M.

AU - Bozzola, L.

AU - Furlan, F.

AU - Di Mario, F.

AU - Valerio, G.

PY - 1999

Y1 - 1999

N2 - 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.

AB - 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.

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