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Metronidazole Resistance Reduces Efficacy of Triple Therapy and Leads to Secondary Clarithromycin Resistance

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Abstract

There has been a significant increase in theprevalence of H. pylori resistance to metronidazole inrecent years, while clarithromycin resistance is stillrelatively rare. In this study we assessed: (1) the effect of primary H. pylori resistance tometronidazole and clarithromycin on the clinicalefficacy of a one-week regimen consisting of omeprazole,metronidazole, and clarithromycin; and (2) the rate of acquisition of secondary antimicrobialresistance after treatment failure. Eighty-sevenpatients with duodenal ulceration or nonulcer dyspepsiawere included in the study. The primary metronidazoleand clarithromycin resistance rates were 35.6% and3.4%, respectively (all three pretreatmentclarithromycin resistant strains had concurrentmetronidazole resistance). H. pylori was eradicated in81.6% of patients. The eradication rate for fullysensitive isolates was 98.2% (55/56) but wassignificantly reduced to 57.1% (16/28) for isolates thatwere resistant to metronidazole alone and 0% (0/3) incases of dual resistance (P < 0.001). Secondaryresistance to clarithromycin was acquired in 58.3% ofcases of treatment failure. In areas of high prevalenceof primary metronidazole resistance, this is asignificant cause of treatment failure with this tripletherapy regimen. This leads to the selection of strainswith dual resistance that are difficult to eradicate andmay contribute to an increase in the prevalence of clarithromycin resistance. In such areas analternative first-line treatment should beprescribed.

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Authors
  1. Martin J. M. Buckley
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  2. Hua-Xiang Xia
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  3. Denise M. Hyde
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  4. Conor T. Keane
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  5. Colm A. O'Morain
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Buckley, M.J.M., Xia, HX., Hyde, D.M. et al. Metronidazole Resistance Reduces Efficacy of Triple Therapy and Leads to Secondary Clarithromycin Resistance. Dig Dis Sci 42, 2111–2115 (1997). https://doi.org/10.1023/A:1018882804607

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