Most Read Articles
01 Oct 2013

Heart disease is still New Zealand’s biggest killer, with one Kiwi dying from coronary heart disease every 90 minutes. Pharmacy Today New Zealand looks at how pharmacists can help

Pearl Toh, 11 Oct 2017
Clinical practice is an art guided by good science, and clinical practice guideline (CPG) is meant to guide in integrating the art and science of clinical practice for the long-term benefits of patients, said Dr Abdul Rashid Abdul Rahman, a consultant cardiovascular physician at An-Nur Specialist Hospital in Bangi, Malaysia, during the 13th Asian-Pacific Congress of Hypertension (APCH) held in Singapore.
Dr. James Salisi, 01 Jul 2014

The recent spike in the number of new cases of human immunodeficiency virus (HIV) infection in the Philippines means that clinicians and pharmacists alike may need to increase their awareness and competency in prescribing and monitoring HIV treatment. Although taught in medical and pharmacy schools, the scarcity in exposure to clinical cases before highlights the need to for physicians and pharmacist to review HIV pharmacotherapy in order to cater to the increasing HIV patient population.

01 Sep 2017
Complementary medicines can play an important part in maintaining wellness, preventing deficiencies and optimizing health outcomes, says Dr Lesley Braun PhD, Director of the Blackmores Institute. 

Antibiotic resistance in H. pylori should influence treatment strategy in Asia-Pacific, suggests new study

Roshini Claire Anthony
11 Sep 2017

The increasing resistance to certain antibiotics in Helicobacter pylori (H. pylori) eradication therapies is associated with a reduction in treatment efficacy in Asia-Pacific countries, and treatments should be adapted accordingly, according to a systematic review and meta-analysis.

“The rise in clarithromycin and levofloxacin resistance in the past 25 years in most countries in the Asia-Pacific region is concerning, and this should prompt the development of effective strategies to control antibiotic resistance,” said the researchers led by Dr Kuo Yu-Ting from the National Taiwan University Hospital Bei-Hu Branch in Taipei, Taiwan.

“First-line treatment strategies should be adapted to resistance patterns on a country-by-country basis … [and] prospective studies are warranted to continuously monitor the prevalence of antibiotic resistance in H. pylori in the Asia-Pacific region,” said Kuo and co-authors.

The systematic review and meta-analysis involved two analyses of studies published between January 1990 and September 2016 – analysis of primary antibiotic resistance (observational studies and RCTs; 176 articles from 24 countries) and analysis of efficacy of first-line H. pylori eradication therapy (RCTs only; 170 articles from 16 countries).

Study participants were adults (aged ≥18 years) diagnosed with H. pylori using a standard diagnostic method, with no history of receiving eradication therapy for H. pylori, and no antibiotic use in the 2 weeks prior to recruitment. 

Primary H. pylori resistance prevalence was most evident for metronidazole (mean prevalence, 44 percent), followed by levofloxacin, clarithromycin, tetracycline, and amoxicillin (mean prevalence, 18, 17, 4, and 3 percent, respectively). [Lancet Gastroenterol Hepatol 2017;doi:10.1016/S2468-1253(17)30219-4]

There was a marked increase in resistance to clarithromycin, metronidazole, and levofloxacin between the years prior to 2000 and 2011–2015 (7 percent to 21 percent for clarithromycin, 36 percent to 45 percent for metronidazole, and 2 percent to 27 percent for levofloxacin), while resistance to amoxicillin and tetracycline did not change drastically over time.

According to the researchers, the increase in clarithromycin resistance could be attributed to the rise in consumption of macrolides, while metronidazole resistance, which was higher in developing countries and lower in countries with higher socioeconomic status, may be linked to the use of this antibiotic for conditions such as parasite infestations or dental infections in developing countries.

Countries with high clarithromycin resistance rates (>20 percent) had a reduced efficacy of clarithromycin-containing H. pylori treatment regimens (<80 percent). Conversely, countries with low clarithromycin resistance (<15 percent) demonstrated higher efficacy of clarithromycin triple therapy (>80 percent).

“These findings collectively suggest that, although clarithromycin-based triple therapy can still be used as the standard first-line treatment in countries where clarithromycin resistance is lower than 15 percent, alternative first-line regimens, such as bismuth quadruple therapy or nonbismuth quadruple therapies, should be considered in countries with high clarithromycin resistance,” said Kuo and co-authors.

The researchers acknowledged the significant heterogeneity between studies, which was influenced by the study regions, periods, resistance-measuring methods, and region-specific infections.

“Our findings provide policy makers with the necessary evidence to decide optimal first-line eradication regimens according to local prevalence of primary antibiotic resistance and develop effective strategies to control the rising antibiotic resistance in their countries,” they said.

 

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Most Read Articles
01 Oct 2013

Heart disease is still New Zealand’s biggest killer, with one Kiwi dying from coronary heart disease every 90 minutes. Pharmacy Today New Zealand looks at how pharmacists can help

Pearl Toh, 11 Oct 2017
Clinical practice is an art guided by good science, and clinical practice guideline (CPG) is meant to guide in integrating the art and science of clinical practice for the long-term benefits of patients, said Dr Abdul Rashid Abdul Rahman, a consultant cardiovascular physician at An-Nur Specialist Hospital in Bangi, Malaysia, during the 13th Asian-Pacific Congress of Hypertension (APCH) held in Singapore.
Dr. James Salisi, 01 Jul 2014

The recent spike in the number of new cases of human immunodeficiency virus (HIV) infection in the Philippines means that clinicians and pharmacists alike may need to increase their awareness and competency in prescribing and monitoring HIV treatment. Although taught in medical and pharmacy schools, the scarcity in exposure to clinical cases before highlights the need to for physicians and pharmacist to review HIV pharmacotherapy in order to cater to the increasing HIV patient population.

01 Sep 2017
Complementary medicines can play an important part in maintaining wellness, preventing deficiencies and optimizing health outcomes, says Dr Lesley Braun PhD, Director of the Blackmores Institute.