2007/05/26 by Lori Fischbach, Eva Evans · 2 citations
Medicine · #Helicobacter pylori-related gastroenterology studies #Clostridium difficile and Clostridium perfringens research #Microscopic Colitis #Clarithromycin #Metronidazole #Medicine #Helicobacter pylori #Drug resistance #Regimen #Internal medicine #Pharmacology #Antibiotics #Antibiotic resistance #Nitroimidazole #Efficacy #Drug #Gastroenterology #Microbiology #Biology #Pathology
paper · doi:10.1111/j.1365-2036.2007.03386.x
openalex publication_date 2007/05/26 · openalex created_date 2016/06/24 · openalex updated_date 2026/07/29
BACKGROUND: Information regarding the effects of drug resistance on therapies for Helicobacter pylori is limited. AIMS: To determine the effect of drug resistance on the efficacy of first-line treatment regimens for H. pylori and identify the most efficacious treatments in the presence of drug resistance. METHODS: We searched for studies using the keywords: 'Helicobacter pylori','resistance' and 'treatment' or 'therapy'. Multilevel meta-regression models were used to determine the effect of drug resistance on treatment efficacy. RESULTS: We analysed data from 93 studies with 10,178 participants. For triple therapies, clarithromycin resistance had a greater effect on treatment efficacy than nitroimidazole resistance. Metronidazole resistance reduced efficacy by 26% in triple therapies containing a nitroimidazole, tetracycline and bismuth, while efficacy was reduced by only 14% when a gastric acid inhibitor was added to the regimen. Quadruple therapies containing both clarithromycin and metronidazole were the most efficacious; >80% of H. pylori infections were consistently eradicated with these regimens. CONCLUSIONS: Drug resistance was a strong predictor of efficacy across triple therapies for the eradication of H. pylori in adults. Resistance to either clarithromycin or metronidazole, but not both simultaneously, may be overcome by using quadruple therapies, especially those containing both clarithromycin and metronidazole.