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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Seven-day triple therapy is a better choice for Helicobacter pylori eradication in regions with low antibiotic resistance
Yue-Feng Tong, Jun Lv, Li-Yuan Ying, Fang Xu, Bo Qin, Ming-Tong Chen, Fei Meng, Miao-Ying Tu, Ning-Min Yang, You-Ming Li, Jian-Zhong Zhang
Yue-Feng Tong, Jun Lv, Li-Yuan Ying, Fang Xu, Bo Qin, Ming-Tong Chen, Department of Gastroenterology, The First People’s Hospital of Yongkang, Yongkang 321300, Zhejiang Province, China
Fei Meng, Miao-Ying Tu, Department of Research Service, Zhiyuan Inspection Medical Institute, Hangzhou 310030, Zhejiang Province, China
Ning-Min Yang, Department of Clinical Laboratory, Zhiyuan Medical Inspection Institute CO., LTD, Hangzhou 310030, Zhejiang Province, China
You-Ming Li, Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310006, Zhejiang Province, China
Jian-Zhong Zhang, State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Jian-Zhong Zhang, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310030, Zhejiang Province, China
Author contributions: Tong YF, Li YM and Zhang JZ formulated the problem; Lv J, Ying LY, Xu F, Qin B and Chen MT collected the samples and designed the treatments; Ying LY, Xu F and Chen MT participated in the follow-up of cases; Tu MY and Yang NM performed Helicobacter pylori isolations and antibiotic susceptibility tests; Tong YF and Meng F analyzed the data and wrote the paper.
Supported by Science and Technology Program of Zhejiang Province, China, No. 2001C23140; National Technology R and D Program in the 12th Five-Year Plan of China, No. 2012BAI06B02; Major Technology Project as part of “Prevention and Control of Major Infectious Diseases including AIDS and Viral Hepatitis”, No. 2013ZX10004216-002; and National Key Scientific Instrument and Equipment Development Project, No. 2012YQ180117.
Institutional review board statement: This study was approved by the Ethics Committee of the National Institute for Communicable Disease Control and Prevention.
Conflict-of-interest statement: To the best of our knowledge, no conflicts of interest exist.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian-Zhong Zhang, MD, State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, China.
zhangjianzhong@icdc.cn
Telephone: +86-10-61739456 Fax: +86-10-61739439
Received: May 21, 2015
Peer-review started: May 23, 2015
First decision: August 26, 2015
Revised: September 10, 2015
Accepted: October 17, 2015
Article in press: October 20, 2015
Published online: December 14, 2015
Processing time: 201 Days and 23.8 Hours
AIM: To investigate whether 7-d triple therapies are still valid in populations with low levels of resistance.
METHODS: A total of 1106 Helicobacter pylori (H. pylori)-positive patients were divided into three groups, each of which received one type of 7-d triple therapy. Therapeutic outcomes of the patients were assessed by the 13C-urea breath test at 8 wk after treatment. The susceptibility of H. pylori to antibiotics was determined by an agar-dilution method. Data analysis was performed by χ2 tests.
RESULTS: The eradication rates in groups A, B and C were 90.71% (332/366), 90.46% (313/346) and 90.87% (189/208), respectively (P = 0.986). The resistance rates were 8.91% for clarithromycin, 14.78% for levofloxacin and 0% for amoxicillin. The eradication rate was significantly different between clarithromycin- and levofloxacin-resistant patients (P < 0.05) in group A. Patients whose treatment failed in group A also had a higher clarithromycin resistance rate than did successive patients (P = 0.034). However, levofloxacin resistance had no obvious influence on the eradication rate. Furthermore, three main antibiotics (clarithromycin, levofloxacin and amoxicillin) had lower DID (defined daily dose per 1000 inhabitants per day) in this city.
CONCLUSION: Clarithromycin resistance is the main reason for the failure of 7-d triple therapy. In populations with low levels of resistance, a 7-d triple therapy is a viable choice. The choice of therapy should not be influenced by conditions in high antibiotic resistance regions.
Core tip: A major cause of treatment failure for Helicobacter pylori (H. pylori) infections is the increasing rate of antibiotic resistance. A total of 1106 H. pylori-positive patients were treated with one of three types of 7-d triple therapies. The results of the 13C-urea breath test during patient follow-up indicated that the eradication rates were greater than 90%. The susceptibility of all H. pylori strains to four antibiotics was determined using an agar-dilution method. We found that the eradication rate was significantly different in antibiotic-resistant patients. In populations with low levels of resistance, 7-d triple therapy is a better choice.
