1887

Abstract

infection causes a number of gastrointestinal diseases and its current treatment is based on multidrug regimes including acid suppression and antimicrobials. The success of these regimes is determined by a number of factors including antibiotic resistance, which varies widely but is an increasing problem. Local data are important in establishing the most cost-effective eradication regime. Data have been collected prospectively on antibiotic resistance at Ipswich Hospital (Suffolk, UK) in all consecutive isolates of from 1991 to 2001. The success of regimes consisting of a proton pump inhibitor, amoxycillin and metronidazole (PPI/A/M) has also been evaluated in patients found positive on serological testing in primary care using urea breath testing. Overall, metronidazole resistance was found in 31.7 % of isolates and clarithromycin resistance in 5.3 %. A significant increase in metronidazole resistance from 29.1 to 37.0 % ( = 0.022) and a decrease in clarithromycin resistance from 10.3 to 3.8 % ( = 0.014) was seen over the study period. Metronidazole resistance was significantly more common in women ( < 0.001) and young patients ( < 0.001). Eradication with PPI/A/M was successful in 89.9 % of patients and did not change significantly over the study period. Eradication rates were lower in young patients ( < 0.001). Whilst metronidazole resistance is increasing in Suffolk, this does not seem to have a significant effect on eradication rates. Metronidazole-based regimes are still effective first-line treatments in most patients.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.05499-0
2004-06-01
2019-11-18
Loading full text...

Full text loading...

/deliver/fulltext/jmm/53/6/JM530611.html?itemId=/content/journal/jmm/10.1099/jmm.0.05499-0&mimeType=html&fmt=ahah

References

  1. Bell, G. D. & Weil, J. ( 1992;). Detection of Helicobacter pylori by the 14C-urea breath test. In Helicobacter pylori and Gastroduodenal Disease, pp. 74–87. Edited by B. J. Rathbone & R. V. Heatley. Oxford: Blackwell Scientific Publications.
  2. Bell, G. D., Weil, J., Harrison, G. & 7 other authors ( 1987;). 14C-urea breath test analysis, a non-invasive test for Campylobacter pylori in the stomach. Lancet i, 1367–1368.
  3. Bell, G. D., Powell, K. U., Burridge, S. M., Bowden, A. F., Atoyebi, W., Bolton, G. H., Jones, P. H. & Brown, C. ( 1995;). Rapid eradication of Helicobacter pylori infection. Aliment Pharmacol Ther 9, 41–46.
    [Google Scholar]
  4. Cabrita, J., Oleastro, M., Matos, R. & 7 other authors ( 2000;). Features and trends in Helicobacter pylori antibiotic resistance in Lisbon area, Portugal (1990–1999). J Antimicrob Chemother 46, 1029–1031.[CrossRef]
    [Google Scholar]
  5. Calam, J. ( 1995;). Clinicians’ Guide to Helicobacter pylori. London: Chapman and Hall.
  6. Graham, D. Y., de Boer, W. A. & Tytgat, G. N. ( 1996;). Choosing the best anti-Helicobacter pylori therapy: effect of antimicrobial resistance. Am J Gastroenterol 91, 1072–1076.
    [Google Scholar]
  7. Jenks, P. J. ( 2002;). Causes of failure of eradication of Helicobacter pylori. BMJ 325, 3–4.[CrossRef]
    [Google Scholar]
  8. Logan, R. P. H. ( 1992;). Detection of Helicobacter pylori by the 13C-urea breath test. In Helicobacter pylori and Gastroduodenal Disease, pp. 88–106. Edited by B. J. Rathbone & R. V. Heatley. Oxford: Blackwell Scientific Publications.
  9. McNulty, C., Owen, R., Tompkins, D., Hawtin, P., McColl, K., Price, A., Smith, G. & Teare, L. ( 2002;). Helicobacter pylori susceptibility testing by disc diffusion. J Antimicrob Chemother 49, 601–609.[CrossRef]
    [Google Scholar]
  10. Megraud, F. ( 1998;). Epidemiology and mechanism of antibiotic resistance in Helicobacter pylori. Gastroenterology 115, 1278–1282.[CrossRef]
    [Google Scholar]
  11. Megraud, F., Lehn, N., Lind, T. & 7 other authors ( 1999;). Antimicrobial susceptibility testing of Helicobacter pylori in a large multicenter trial: the MACH 2 study. Antimicrob Agents Chemother 43, 2747–2752.
    [Google Scholar]
  12. Meyer, J. M., Silliman, N. P., Wang, W. & 7 other authors ( 2002;). Risk factors for Helicobacter pylori resistance in the United States: the surveillance of H.pylori antimicrobial resistance partnership (SHARP) study, 1993–1999. Ann Intern Med 136, 13–24.[CrossRef]
    [Google Scholar]
  13. Mollison, L. C., Stingemore, N., Wake, R. A., Cullen, D. J. & McGechie, D. B. ( 2000;). Antibiotic resistance in Helicobacter pylori. Med J Aust 173, 521–523.
    [Google Scholar]
  14. Osato, M. S., Reddy, R., Reddy, S. G., Penland, R. L., Malaty, H. M. & Graham, D. Y. ( 2001;). Pattern of primary resistance of Helicobacter pylori to metronidazole or clarithromycin in the United States. Arch Intern Med 161, 1217–1220.[CrossRef]
    [Google Scholar]
  15. Trowell, J. E., Yoong, A. K. H., Saul, K. J., Gant, P. W. & Bell, G. D. ( 1987;). Simple half-gram stain for showing presence of Campylobacter pyloridis in sections. J Clin Pathol 40, 702. 702.
    [Google Scholar]
  16. Weil, J., Bell, G. D., Powell, K. U., Jobson, R., Trowell, J. E., Gant, P. W. & Jones, P. H. ( 1990;). Helicobacter pylori and metronidazole resistance. Lancet 336, 1445. 1445.
    [Google Scholar]
  17. Wolle, K., Leodolter, A., Malfertheiner, P. & Konig, W. ( 2002;). Antibiotic susceptibility of Helicobacter pylori in Germany: stable primary resistance from 1995 to 2000. J Med Microbiol 51, 705–709.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.05499-0
Loading
/content/journal/jmm/10.1099/jmm.0.05499-0
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error