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- Title
Role of MIC levels of resistance to clarithromycin and metronidazole in Helicobacter pylori eradication.
- Authors
Francesco, Vincenzo De; Zullo, Angelo; Fiorini, Giulia; Saracino, Ilaria M; Pavoni, Matteo; Vaira, Dino; De Francesco, Vincenzo
- Abstract
<bold>Objectives: </bold>Antimicrobial resistance to clarithromycin and metronidazole significantly affects the cure rate of standard therapies for Helicobacter pylori infection. We tested whether different MIC levels of resistance to these antibiotics play a role in therapeutic efficacy.<bold>Methods: </bold>This was a post hoc analysis of data from a therapeutic trial in which patients with antibiotic susceptibility testing (Etest) received first-line sequential therapy. The level of antibiotic resistance was classified according to MIC values into low (MIC from >0.5 to ≤8 for clarithromycin, and from >8 to ≤32 for metronidazole) and high (MIC from >8 to 256 mg/L for clarithromycin, and from >32 to 256 mg/L for metronidazole).<bold>Results: </bold>Data from 1006 patients were included. There were 520 (51.7%) patients with susceptible strains, 136 (13.5%) with clarithromycin-resistant strains, 144 (14.3%) with metronidazole-resistant strains and 206 (20.5%) with clarithromycin-resistant and metronidazole-resistant strains. In the presence of double resistance, the cure rate was still high (38/41, 92.7%) when MIC levels were low and it was reduced (94/112, 83.9%) only when MIC levels of both antibiotics were high. The cure rates did not significantly differ between patients with single antibiotic-resistant strains, irrespective of MIC values, and those with susceptible strains.<bold>Conclusions: </bold>We found that MIC levels of resistance to either clarithromycin or metronidazole play a role in H. pylori therapy outcome and that bacterial resistance becomes relevant in vivo when clarithromycin-resistant and metronidazole-resistant strains have high MIC values for at least one of these antibiotics.
- Subjects
DRUG resistance; METRONIDAZOLE; CLARITHROMYCIN; HELICOBACTER; GASTRITIS; ANTIBIOTICS; COMBINATION drug therapy; DRUG resistance in microorganisms; HELICOBACTER diseases; HELICOBACTER pylori; MICROBIAL sensitivity tests; TREATMENT effectiveness; PHARMACODYNAMICS
- Publication
Journal of Antimicrobial Chemotherapy (JAC), 2019, Vol 74, Issue 3, p772
- ISSN
0305-7453
- Publication type
journal article
- DOI
10.1093/jac/dky469