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The importance of the level of metronidazole resistance for the success of Helicobacter pylori eradication
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2004 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, Vol. 19, no 12, 1315-1321 p.Article in journal (Refereed) Published
Abstract [en]

Aims: To evaluate the role of antibiotic susceptibility for the treatment outcome of proton pump inhibitor-dependent and independent Helicobacter pylori eradication regimens. Methods: In a placebo-controlled clinical study of peptic ulcer patients with H. pylori infection, patients were randomized to receive lansoprazole, clarithromycin and tinidazole twice-daily, clarithromycin and tinidazole once-daily with lansoprazole or with placebo. Helicobacter pylori status was assessed by culture and antibiotic susceptibility by E-test minimal inhibitory concentration (MIC) in 205 clinical isolates. Results: Primary resistance to clarithromycin and metronidazole was 1 and 76%, respectively. In metronidazole susceptible strains eradication rates were similar at > 90% for all treatment groups (P = 0.49). With low-level metronidazole resistance (4 μg/ mL < MIC < 256 μg/mL), eradication rates were similar at >75% (P = 0.80). The major difference was found at high-level metronidazole resistance (MIC ≥ 256 μg/mL) with 95%, 58% and 21% eradication in the lansoprazole, clarithromycin and tinidazole twice-daily, lansoprazole, clarithromycin and tinidazole once-daily and placebo, clarithromycin and tinidazole once-daily groups, respectively (P < 0.001). Conclusion: In the absence of antibiotic resistance, a once-daily therapy of only clarithromycin and tinidazole can achieve a high rate of H. pylori eradication. Such a combination could offer a simpler and cheaper treatment option for developing countries. The standard, twice-daily proton pump inhibitor-based triple therapy was shown to be efficient in H. pylori eradication even in the presence of high-level metronidazole resistance.

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2004. Vol. 19, no 12, 1315-1321 p.
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Medical and Health Sciences
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URN: urn:nbn:se:liu:diva-24682DOI: 10.1111/j.1365-2036.2004.01959.xLocal ID: 6916OAI: oai:DiVA.org:liu-24682DiVA: diva2:245004
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2011-01-12

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Nilsson, Lennart

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