Most Read Articles
Elaine Soliven, 27 Sep 2017
A second dose of kisspeptin-54 improves oocyte yield in women at high risk of ovarian hyperstimulation syndrome (OHSS) during in vitro fertilization (IVF) treatment, according to a recent study.
23 Oct 2017
Pearl Toh spoke with Dr Teh Ming Ming, senior consultant at the Department of Endocrinology, Singapore General Hospital (SGH), on the major challenges of diagnosing and managing diabetes in primary care, in conjunction with the World Diabetes Day on 14 November. Awareness of the symptoms of diabetes is important, and patients should be empowered to manage their conditions.
Rachel Soon, Yesterday

Pharmacists can and should utilize their positions within communities to provide access to an extended range of healthcare services, says an expert.

01 Aug 2017
New drug applications approved by US FDA as of 1 - 15 June 2017 which includes New Molecular Entities (NMEs) and new biologics. It does not include Tentative Approvals. Supplemental approvals may have occurred since the original approval date.

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.

 

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Pharmacy - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Elaine Soliven, 27 Sep 2017
A second dose of kisspeptin-54 improves oocyte yield in women at high risk of ovarian hyperstimulation syndrome (OHSS) during in vitro fertilization (IVF) treatment, according to a recent study.
23 Oct 2017
Pearl Toh spoke with Dr Teh Ming Ming, senior consultant at the Department of Endocrinology, Singapore General Hospital (SGH), on the major challenges of diagnosing and managing diabetes in primary care, in conjunction with the World Diabetes Day on 14 November. Awareness of the symptoms of diabetes is important, and patients should be empowered to manage their conditions.
Rachel Soon, Yesterday

Pharmacists can and should utilize their positions within communities to provide access to an extended range of healthcare services, says an expert.

01 Aug 2017
New drug applications approved by US FDA as of 1 - 15 June 2017 which includes New Molecular Entities (NMEs) and new biologics. It does not include Tentative Approvals. Supplemental approvals may have occurred since the original approval date.