Information regarding the effects of drug resistance on therapies for Helicobacter pylori is limited.
Dr Fischbach and colleagues from Texas, USA determined the effect of drug resistance on the efficacy of first-line treatment regimens for H. pylori.
The team identified the most efficacious treatments in the presence of drug resistance.
|Metronidazole resistance reduced efficacy by 26% in triple therapies|
|Alimentary Pharmacology & Therapeutics|
The team searched for studies using the keywords ‘Helicobacter pylori', ‘resistance' and ‘treatment' or ‘therapy'.
Multilevel meta-regression models were used to determine the effect of drug resistance on treatment efficacy.
The researchers analyzed data from 93 studies with 10,178 participants.
The team found that for triple therapies, clarithromycin resistance had a greater effect on treatment efficacy than nitroimidazole resistance.
Metronidazole resistance reduced efficacy by 26% in triple therapies containing a nitroimidazole, tetracycline and bismuth.
The researchers noted that efficacy was reduced by only 14% when a gastric acid inhibitor was added to the regimen.
Quadruple therapies containing both clarithromycin and metronidazole were the most efficacious.
The team observed that over 80% of H. pylori infections were consistently eradicated with these regimens.
Dr Fischbach's team concluded, "Drug resistance was a strong predictor of efficacy across triple therapies for the eradication of H. pylori in adults."
"Resistance to either clarithromycin or metronidazole, but not both simultaneously, may be overcome by using quadruple therapies, especially those containing both clarithromycin and metronidazole."