Year 2019 / Volume 111 / Number 9
Original
Tailored Helicobacter pylori eradication based on prior intake of macrolide antibiotics allows the use of triple therapy with optimal results in an area with high clarithromycin resistance

655-661

DOI: 10.17235/reed.2019.6198/2019

Julio Valle Muñoz, Pablo Muñoz Gómez, Cristian Sierra Bernal, Eva de Andrés, César Gómez Hernando, Rafael Gómez Rodríguez,

Abstract
Background: the previous intake of macrolide antibiotics is associated with a failure to eradicate Helicobacter pylori (H. pylori) with clarithromycin-containing regimens. However, the standard triple therapy achieves eradication rates of over 90% in patients without a previous use of macrolides in our health area. The aim of this study was to evaluate the efficacy of an H. pylori eradication strategy based on the intake of macrolides by the patient during the previous years. Methods: one hundred and sixty-nine patients with H. pylori infection were prospectively included in the study. The electronic medical record of each patient was reviewed at the time of inclusion. Depending on their previous intake of macrolides, patients were assigned to one of two eradication regimens: group A) patients without a previous intake of macrolides received an optimized triple therapy for 14 days; and group B) patients with a previous intake of macrolides received bismuth quadruple therapy for ten days. Results: ninety-one patients (53.84%) without a previous intake of macrolides received an optimized triple therapy (group A) and 78 patients (46.15%) with a previous intake of macrolides received bismuth quadruple therapy (group B). In group A, the H. pylori eradication rates were 90.11% in the intention-to-treat and 95.35% in the per-protocol analysis. In group B, the H. pylori eradication rates were 85.89% in the intention-to-treat and 98.5% in the per-protocol analysis. The overall eradication rates obtained using this strategy were 88.16% (95% CI: 82.32-92.02%) in the intention-to-treat and 96.75% (95% CI: 92.59-98.94%) in the per-protocol analysis. Conclusions: an H. pylori eradication strategy based on the intake of macrolides during the previous years achieves overall eradication rates close to 90% and allows the use of standard triple therapy in more than half of the patients from a health area with a high level of clarithromycin resistance.
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References
1. Thung I, Aramin H, Vavinskaya V, Gupta S, Park JY, Crowe SE, Valasek MA. Review article: the global emergence of Helicobacter pylori antibiotic resistance. Aliment Pharmacol Ther 2016; 43:514-533.
2. Gatta L, Scarpignato C, Fiorini G, Belsey J, Saracino IM, Ricci C, Vaira D. Impact of primary antibiotic resistance on the effectiveness of sequential therapy for Helicobacter pylori infection: lessons from a 5-year study on a large number of strains. Aliment Pharmacol Ther 2018; 47:1261-1269.
3. Tankovic J, Lamarque D, Lascols C, Soussy CJ, Delchier JC. Impact of Helicobacter pylori resistance to clarithromycin on the efficacy of the omeprazole-amoxicillin-clarithromycin therapy. Aliment Pharmacol Ther 2001; 15:707-713.
4. Lee JH, Shin JH, Roe IH, Sohn SG, Lee JH, Kang GH, Lee HK, Jeong BC, Lee SH. Impact of clarithromycin resistance on eradication of Helicobacter pylori in infected adults. Antimicrob Agents Chemother 2005; 49:1600-1603.
5. Savoldi A, Carrara E, Graham DY, Conti M, Tacconelli E. Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta-Analysis in World Health Organization Regions. Gastroenterology 2018; Doi: 10.1053/j.gastro.2018.07.007.
6. Yang JC, Lu CW, Lin CJ. Treatment of Helicobacter pylori infection: current status and future concepts. World J Gastroenterol 2014; 20:5283-5293.
7. Fischbach L, Evans EL. Meta-analysis: the effect of antibiotic resistance status on the efficacy of triple and quadruple first-line therapies for Helicobacter pylori. Alimentary Pharmacology and Therapeutics 2007; 26: 343-357.
8. Agudo S, Pérez-Pérez G, Alarcón T, López-Brea M. High prevalence of clarithromycin-resistant Helicobacter pylori strains and risk factors associated with resistance in Madrid, Spain. J Clin Microbiol 2010; 48:3703-3707.
9. Tamayo E, Montes M, Fernández-Reyes M, Lizasoan J, Ibarra B, Mendarte U, Zapata E, Mendiola J, Pérez-Trallero E. Clarithromycin resistance in Helicobacter pylori and its molecular determinants in Northern Spain, 2013-2015. J Glob Antimicrob Resist 2017; 9:43-46.
10. Macías-García F, Llovo-Taboada J, Díaz-López M, Bastón-Rey I, Domínguez-Muñoz JE. High primary antibiotic resistance of Helicobacter Pylori strains isolated from dyspeptic patients: A prevalence cross-sectional study in Spain. Helicobacter 2017; 22(6). doi: 10.1111/hel.12440.
11. Navarro-Jarabo JM, Fernández-Sánchez F, Fernández-Moreno N, Hervas-Molina AJ, Casado-Caballero F, Puente-Gutierrez JJ, Pallares-Manrique H, Rodríguez-Ramos C, Fernández-Gutierrez C, Pérez-Aisa A, Rivas-Ruiz F, Montiel Quezel-Guerraz N. Prevalence of Primary Resistance of Helicobacter pylori to Clarithromycin and Levofloxacin in Southern Spain. Digestion 2015; 92:78-82.
12. Malfertheiner P, Megraud F, O'Morain CA, Gisbert JP, Kuipers EJ, Axon AT, Bazzoli F, Gasbarrini A, Atherton J, Graham DY, Hunt R, Moayyedi P, Rokkas T, Rugge M, Selgrad M, Suerbaum S, Sugano K, El-Omar EM, on behalf of the European Helicobacter and Microbiota Study Group and Consensus panel. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut 2017; 66:6-30.
13. O'Morain NR, Dore MP, O'Connor AJP, Gisbert JP, O'Morain CA. Treatment of Helicobacter pylori infection in 2018. Helicobacter 2018; 23: Suppl 1:e12519. doi: 10.1111/hel.12519.
14. Sugimoto M, Uotani T, Sahara S, Ichikawa H, Yamade M, Sugimoto K, Furuta T. Efficacy of tailored Helicobacter pylori eradication treatment based on clarithromycin susceptibility and maintenance of acid secretion. Helicobacter 2014; 19:312-318.
15. Miyaki A, Yamaguchi K, Ida A, Miyauchi T. An assessment of the efficacy of first-line Helicobacter pylori-eradication therapy based on clarithromycin susceptibility. Minerva Gastroenterol Dietol 2016; 62:234-239.
16. Cosme A, Lizasoan J, Montes M, Tamayo E, Alonso H, Mendarte U, Martos M, Fernández-Reyes M, Saraqueta C, Bujanda L. Antimicrobial susceptibility guided therapy versus empirical concomitant therapy for eradication of Helicobacter pylori in a region with high rate of clarithromycin resistance. Helicobacter 2016; 21:29-34.
17. McMahon BJ, Hennessy TW, Bensler JM, Bruden DL, Parkinson AJ, Morris JM, Reasonover AL, Hurlburt DA, Bruce MG, Sacco F, Butler JC. The relationship among previous antimicrobial use, antimicrobial resistance, and treatment outcomes for Helicobacter pylori infections. Ann Intern Med 2003; 139:463-469.
18. Megraud F, Coenen S, Versporten A Kist M, Lopez-Brea M, Hirschl AM, Andersen LP, Goossens H, Glupczynski Y; Study Group participants. Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut 2013; 62:34–42.
19. Lim SG, Park RW, Shin SJ, Yoon D, Kang JK, Hwang JC, Kim SS, Kim JH, Lee KM. The relationship between the failure to eradicate Helicobacter pylori and previous antibiotics use. Dig Liver Dis 2016; 48:385-390.
20. Muñoz-Gómez P, Jordán-Castro JA, Abanades-Tercero M, Blanco-González JJ, Andrés-Esteban EM, Valle-Muñoz J. Macrolide use in the previous years is associated with failure to eradicate Helicobacter pylori with clarithromycin-containing regimens. Helicobacter 2018; Feb 23 doi: 10.1111/hel.12452. Epub 2017 Nov 26.
21. Graham DY, Fischbach L. Helicobacter pylori treatment in the era of increasing antibiotic resistance. Gut 2010; 59:1143–1153.
22. Rimbara E, Fischbach LA, Graham DY. Optimal therapy for Helicobacter pylori infections. Nat Rev Gastroenterol Hepatol 2011; 8:79–88.
23. Belletti D, Zacker C, Mullins CD. Perspectives on electronic medical records adoption: electronic medical records (EMR) in outcomes research. Patient Relat Outcome Meas 2010; 1:29-37.
24. Malfertheiner P, Megraud F, O’Morain CA, Atherton J, Axon ATR, Bazzoli F, Gensini GF, Gisbert JP, Graham DY, Rokkas T, El-Omar EM, Kuipers EJ, The European Helicobacter Study Group (EHSG). Management of Helicobacter pylori infection–the Maastricht IV/Florence Consensus Report. Gut 2012; 61:646-664.
25. Gisbert JP, Calvet X, Bermejo F, Boixeda D, Bory F, Bujanda L, Castro-Fernández M, Dominguez-Muñoz E, Elizalde JI, Forné M, Gené E, Gomollón F, Lanas A, Martín de Argila C, McNicholl AG, Mearin F, Molina-Infante J, Montoro M, Pajares JM, Pérez-Aisa A, Pérez-Trallero E, Sánchez-Delgado J. III Spanish Consensus Conference on Helicobacter pylori infection. Gastroenterol Hepatol 2013; 36:340-374.
26. Laine L, Estrada R, Trujillo M, Knigge K, Fennerty MB. Effect of proton-pump inhibitor therapy on diagnostic testing for Helicobacter pylori. Ann Intern Med 1998; 129:547–550.
27. Tursi A, Franceschi M, Allegretta L, Savarino E, De Bastiani R, Elisei W, Baldassarre G, Ferronato A, Scida S, Miraglia C, Penna A, Licci C, Rizzo GL, Pranzo G, Cassieri C, Brandimarte G, Picchio M, Di Mario F. Effectiveness and safety of Pylera® in patients infected by Helicobacter pylori: A Multicenter, retrospective, real life study. Dig Dis 2018; 36:264-268.
28. Mégraud F. Antibiotic Resistance: The Key Element to Consider in Helicobacter pylori Treatment. Gastroenterology 2018; Doi: 10.1053/j.gastro.2018.10.012.
29. Wenzhen Y, Yumin L, Quanlin G, Kehu Y, Lei J, Donghai W, Lijuan Y. Is antimicrobial susceptibility testing necessary before first-line treatment for Helicobacter pylori infection? Meta-analysis of randomized controlled trials. Intern Med 2010; 49:1103-1109.
30. Fallone CA, Chiba N, van Zanten SV, Fischbach L, Gisbert JP, Hunt RH, Jones NL, Render C, Leontiadis GI, Moayyedi P, Marshall JK. The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults. Gastroenterology 2016; 15:51-69.
31. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol 2017; 112:212-239.
32. Jordán-Castro JA, Valle-Muñoz J, Muñoz-Rosas C, Tordera J, Blanco-González J. Helicobacter pylori eradication rates with concomitant quadruple therapy and with optimized triple therapy in Toledo′s health area: randomized clinical trial. Rev ACAD 2017; 33: 79-84.
33. Adrian G. McNicholl, Olga P. Nyssen, Dmitry Stanislavovich Bordin, Bojan Tepes, Angeles Perez-Aisa, Dino Vaira, Maria Caldas, Luis Bujanda, Manuel Castro-Fernandez, Frode Lerang, Marcis Leja, Luis Rodrigo, Theodore Rokkas, Limas Kupcinskas, Jorge Pérez-Lasala, Laimas Virginijus Jonaitis, Oleg Shvets, Antonio Gasbarrini, Halis Simsek, Anthony Thomas Roger Axon, György Miklós Buzás, Jose Carlos Machado, Yaron Niv, Lyudmila Boyanova, Adrian Goldis, Vincent Lamy, Miroslava Katicic, Krzysztof Przytulski, Christoph Beglinger, Marino Venerito, Peter Bytzer, Lisette G. Capelle, Tomica Milosavljevic, Lea Irene Veijola, Javier Molina-Infante, Liudmila Vologzhanina, Galina Fadeenko, Ines Ariño, Giulia Fiorini, Mercedes Ramas, Maria G. Donday, Francis Megraud, Colm O'Morain, Javier P. Gisbert, On behalf of the Hp-EuReg Investigators. Pan-European Registry on H. pylori Management (Hp-EuReg): Interim Analysis of 16,600 first-line treatments. (Abstract). XXXI International Workshop on Helicobacter & microbiota in inflammation and cancer. Kaunas ( Lithuania), Sept 2018.
34. Selgrad M, Meissle J, Bornschein J, Kandulski A, Langner C, Varbanova M, WexT, Tammer I, Schlüter D, Malfertheiner P. Antibiotic susceptibility of Helicobacter pylori in central Germany and its relationship with the number of eradication therapies. Eur J Gastroenterol Hepatol 2013; 25:1257-1260.
35. Muñoz N, Sánchez-Delgado J, Baylina M, López-Góngora S, Calvet X. Prevalence of Helicobacter pylori resistance after failure of first-line therapy. A systematic review. Gastroenterol Hepatol 2018; doi: 10.1016/j.gastrohep.2018.06.014.
36. Malfertheiner P, Bazzoli F, Delchier JC, Celiñski K, Giguère M, Rivière M, Mégraud F; Pylera Study Group. Helicobacter pylori eradication with a capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline given with omeprazole versus clarithromycin-based triple therapy: a randomised, open-label, non-inferiority, phase 3 trial. Lancet 2011; 377:905-913.
37. Roberts RM, Bartoces M, Thompson SE, Hicks LA. Antibiotic prescribing by general dentists in the United States, 2013. J Am Dent Assoc. 2017; 148:172-178.
38. Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, Colomb-Cotinat M, Kretzschmar ME, Devleesschauwer B, Cecchini M, Ouakrim DA, Oliveira TC, Struelens MJ, Suetens C, Monnet DL; Burden of AMR Collaborative Group. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis 2018; doi:10.1016/S1473-3099(18)30605-4.
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Valle Muñoz J, Muñoz Gómez P, Sierra Bernal C, de Andrés E, Gómez Hernando C, Gómez Rodríguez R, et all. Tailored Helicobacter pylori eradication based on prior intake of macrolide antibiotics allows the use of triple therapy with optimal results in an area with high clarithromycin resistance. 6198/2019


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Publication history

Received: 28/01/2019

Accepted: 23/03/2019

Online First: 26/07/2019

Published: 05/09/2019

Article revision time: 49 days

Article Online First time: 179 days

Article editing time: 220 days


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