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World J Gastroenterol. 2015 Oct 7;21(37):10669-74. doi: 10.3748/wjg.v21.i37.10669.

Five-year sequential changes in secondary antibiotic resistance of Helicobacter pylori in Taiwan.

Author information

1
I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.

Abstract

AIM:

To determine changes in the antibiotic resistance of Helicobacter pylori (H. pylori) in southern Taiwan after failure of first-line standard triple therapy.

METHODS:

We analyzed 137 H. pylori-infected isolates from patients who experienced eradication failure after standard first-line triple therapy from January 2010 to December 2014. The H. pylori strains were tested for susceptibility to amoxicillin, clarithromycin, levofloxacin, metronidazole and tetracycline using the E-test method. The minimal inhibitory concentration (MIC) was determined by the agar dilution test. MIC values of ≥ 0.5, ≥ 1, ≥ 1, ≥ 4 and ≥ 8 mg/L were considered to be the resistance breakpoints for amoxicillin, clarithromycin, levofloxacin, tetracycline and metronidazole, respectively.

RESULTS:

A high resistance rate was found for clarithromycin (65%-75%) and metronidazole (30%-40%) among patients who failed first-line standard therapy. The resistance levels to amoxicillin and tetracycline remained very low; however, levofloxacin resistance was as high as 37.5% in 2010 but did not increase any further during the past 5 years. The rates of resistance to these antibiotics did not show a statistically significant upward or downward trend.

CONCLUSION:

Antibiotic resistance of H. pylori remains a problem for the effective eradication of this pathogen and its associated diseases in Taiwan. High clarithromycin resistance indicated that this antibiotic should not be prescribed as a second-line H. pylori eradication therapy. Moreover, levofloxacin-based second-line therapy should be used cautiously, and the local resistance rates should be carefully monitored.

KEYWORDS:

Antibiotic resistance; Failed first-line therapy; Five-year sequential changes; Helicobacter pylori; Southern Taiwan

PMID:
26457027
PMCID:
PMC4588089
DOI:
10.3748/wjg.v21.i37.10669
[Indexed for MEDLINE]
Free PMC Article

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