The relationship among previous antimicrobial use, antimicrobial resistance, and treatment outcomes for Helicobacter pylori infections.
ABSTRACT The relationship between previous antimicrobial treatments and infection with drug-resistant Helicobacter pylori is unknown.
To determine whether previous use of antimicrobial agents predicts subsequent antibiotic resistance of H. pylori and whether resistance affects treatment outcome.
Retrospective cohort analysis of adults recruited sequentially from a clinical practice.
A referral hospital in Anchorage, Alaska.
125 adults infected with H. pylori.
Medical records were reviewed for antimicrobial agents prescribed in the 10 years before diagnosis with H. pylori infection. Antimicrobial susceptibility of H. pylori isolates obtained from endoscopic gastric biopsy was determined by using agar dilution. Cure was determined by using the urea breath test 2 months after antimicrobial treatment.
Among the 125 patients, 37 (30%) were found to have H. pylori isolates resistant to clarithromycin and 83 (66%) were found to have H. pylori isolates resistant to metronidazole. Resistance to clarithromycin was associated with previous use of any macrolide antibiotic (P < 0.001), and resistance to metronidazole was associated with previous use of metronidazole (P < 0.001). The odds of isolates being resistant to clarithromycin increased in relation to the number of courses of macrolides received (P < 0.001). Among 53 persons treated with clarithromycin-based regimens, treatment failed in 77% of those carrying clarithromycin-resistant H. pylori (10 of 13) and 13% of those with clarithromycin-susceptible strains (5 of 40) (relative risk, 6.2 [95% CI, 1.9 to 37.1]; P < 0.001).
Previous use of macrolides and metronidazole is associated with H. pylori resistant to these antimicrobial agents. Clarithromycin resistance is associated with a greater risk for failure with clarithromycin-based treatments.
Article: International Circumpolar Surveillance, an Arctic network for the surveillance of infectious diseases.[show abstract] [hide abstract]
ABSTRACT: Peoples of the Arctic and sub-Arctic regions live in social and physical environments that differ substantially from those of their more southern-dwelling counterparts. The cold northern climate keeps people indoors, amplifying the effects of household crowding, smoking, and inadequate ventilation on person-to-person spread of infectious disease. The emergence of antimicrobial drug resistance among bacterial pathogens, the reemergence of tuberculosis, the entrance of HIV into Arctic communities, and the spectre of pandemic influenza or the sudden emergence and introduction of new viral pathogens such as severe acute respiratory syndrome are of increasing concern to residents, governments, and public health authorities. The International Circumpolar Surveillance system is a network of hospital, public health agencies, and reference laboratories throughout the Arctic linked together to collect, compare, and share uniform laboratory and epidemiologic data on infectious diseases and assist in the formulation of prevention and control strategies.Emerging infectious diseases 02/2008; 14(1):18-24. · 6.17 Impact Factor
Article: Clinical evaluation of dyspepsia in patients with functional dyspepsia, with the history of Helicobacter pylori eradication therapy in Cipto Mangunkusumo Hospital, Jakarta.[show abstract] [hide abstract]
ABSTRACT: to obtain the proportion of dyspepsia symptom in non-ulcerative dyspepsia patient after eradication treatment of H. pylori, and recent status of H. pylori after eradication therapy. cross-sectional study in patients with history symptoms of dyspepsia in non ulcer dyspepsia with positive H. pylori and had been administered eradication treatment of H. pylori for 1 week in 2002-2007 period. Conditions that influence the result of urea breath test such as proton pump inhibitor, antibiotic treatment, and gastric malignancy have been excluded. Patients were invited to be interviewed about current symptoms of dyspepsia and then underwent urea breath test (UBT) examination to identify H. pylori. Global overall symptom of dyspepsia scale was used to assess the symptoms of dyspepsia. twenty one patients (14 male and 11 female) fulfilled the eligibility criteria for this study, 9 patients with eradication treatment history less than 1 year, and 12 patients more than 1 year. The symptoms of dyspepsia were evaluated and as many as 17 patients (81%) dyspepsia symptoms' were subsided and 4 patients had persistent symptoms after eradication. After eradication treatment, 17 patients (81%) resulted with negative Helicobacter pylori findings, and 4 patients remained positive. One patient of the positive group was reinfected by H. pylori, proved by previous negative result of UBT. In the negative group, 13 patients (76.4%) dyspepsia symptoms' were free from dyspepsia symptoms, and 4 patients had persistent symptoms. All the symptoms of the patients in the positive group were relieved. majority of patients had improvement of dyspepsia symptoms after eradication treatment, and 81% of patients had negative H. pylori findings, proved by UBT after eradication. The percentage of symptomatic improvement on H. pylori negative patients after eradication is 76.4%.Acta medica Indonesiana 04/2010; 42(2):86-93.
[show abstract] [hide abstract]
ABSTRACT: Antimicrobial susceptibility of 120 Helicobacter pylori isolates to metronidazole, tetracycline, clarithromycin, and amoxicillin was determined, and 77.5, 15, 10, and 6.6% of the isolates, respectively, were resistant. Only rdxA inactivation and both rdxA and frxA inactivation were responsible for metronidazole resistance in 66% (8 of 12) and 33% (4 of 12) of the isolates, respectively.Journal of Clinical Microbiology 11/2004; 42(10):4856-8. · 4.15 Impact Factor