Update on Clarithromycin Resistance in Helicobacter pylori in Hong Kong and Its Effect on Clarithromycin-Based Triple TherapyGu Q.a, b · Xia H.H.X.b · Wang J.D.b · Wong W.M.b · Chan A.O.O.b · Lai K.C.b · Chan C.K.b · Yuen M.F.b · Fung F.M.Y.b · Wong K.W.b · Lam S.K.b · Wong B.C.Y.b
aDepartment of Gastroenterology, The First Hospital, Peking University, Beijing, and bDepartment of Medicine, University of Hong Kong, Hong Kong, SAR, China
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Aim: To determine the antibiotic susceptibility of Helicobacter pylori and evaluate the efficacy of a clarithromycin-based triple therapy in relation to antibiotic resistance. Methods: Consecutive patients referred for upper endoscopy due to dyspeptic symptoms were recruited. Gastric biopsies were obtained for the CLO test, histology and culture. Antibiotic susceptibility was assessed by the E-test. Patients with H. pylori infection received rabeprazole 20 mg, clarithromycin 500 mg, and amoxicillin 1,000 mg, all twice daily for 7 days. Results: Of 234 patients recruited, 124 were H. pylori-positive and culture was successful in 102 patients. The updated prevalences of resistance to clarithromycin, amoxicillin and metronidazole were 7.8, 0 and 39.2%, respectively. A total of 86 patients received 1-week triple therapy with rabeprazole 20 mg, clarithromycin 500 mg, and amoxicillin 1,000 mg, all twice daily, and 81 patients attended the follow-up test. Eradication rates by per-protocol and intention-to-treat analysis were 92.6 and 87.2%, respectively. The eradication rate by per protocol was significantly higher in patients with clarithromycin-susceptible strains than in those with clarithromycin-resistant strains (98.6 vs. 28.6%, p < 0.001). Conclusion: Clarithromycin resistance reduces the clinical efficacy of clarithromycin-based triple therapy. However, due to the low prevalence of clarithromycin resistance, clarithromycin-based therapy is still the first choice for clinical use.
© 2006 S. Karger AG, Basel
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