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Subsomwong P, Doohan D, Fauzia KA, Akada J, Matsumoto T, Yee TT, Htet K, Waskito LA, Tuan VP, Uchida T, Matsuhisa T, Yamaoka Y. Next-Generation Sequencing-Based Study of Helicobacter pylori Isolates from Myanmar and Their Susceptibility to Antibiotics. Microorganisms 2022; 10:microorganisms10010196. [PMID: 35056645 PMCID: PMC8781859 DOI: 10.3390/microorganisms10010196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 02/01/2023] Open
Abstract
Evaluation of Helicobacter pylori resistance to antibiotics is crucial for treatment strategy in Myanmar. Moreover, the genetic mechanisms involved remain unknown. We aimed to investigate the prevalence of H. pylori infection, antibiotic resistance, and genetic mechanisms in Myanmar. One hundred fifty patients from two cities, Mawlamyine (n = 99) and Yangon (n = 51), were recruited. The prevalence of H. pylori infection was 43.3% (65/150). The successfully cultured H. pylori isolates (n = 65) were tested for antibiotic susceptibility to metronidazole, levofloxacin, clarithromycin, amoxicillin, and tetracycline by Etest, and the resistance rates were 80%, 33.8%, 7.7%, 4.6%, and 0%, respectively. In the multidrug resistance pattern, the metronidazole–levofloxacin resistance was highest for double-drug resistance (16/19; 84.2%), and all triple-drug resistance (3/3) was clarithromycin–metronidazole–levofloxacin resistance. Twenty-three strains were subjected to next-generation sequencing to study their genetic mechanisms. Interestingly, none of the strains resistant to clarithromycin had well-known mutations in 23S rRNA (e.g., A2142G, A2142C, and A2143G). New type mutation genotypes such as pbp1-A (e.g., V45I, S/R414R), 23S rRNA (e.g., T248C), gyrA (e.g., D210N, K230Q), gyrB (e.g., A584V, N679H), rdxA (e.g., V175I, S91P), and frxA (e.g., L33M) were also detected. In conclusion, the prevalence of H. pylori infection and its antibiotic resistance to metronidazole was high in Myanmar. The H. pylori eradication regimen with classical triple therapy, including amoxicillin and clarithromycin, can be used as the first-line therapy in Myanmar. In addition, next-generation sequencing is a powerful high-throughput method for identifying mutations within antibiotic resistance genes and monitoring the spread of H. pylori antibiotic-resistant strains.
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Affiliation(s)
- Phawinee Subsomwong
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (P.S.); (D.D.); (K.A.F.); (J.A.); (T.M.); (L.A.W.); (V.P.T.)
- Department of Microbiology and Immunology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Dalla Doohan
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (P.S.); (D.D.); (K.A.F.); (J.A.); (T.M.); (L.A.W.); (V.P.T.)
- Department of Public Health and Preventive Medicine, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Kartika Afrida Fauzia
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (P.S.); (D.D.); (K.A.F.); (J.A.); (T.M.); (L.A.W.); (V.P.T.)
- Department of Public Health and Preventive Medicine, Universitas Airlangga, Surabaya 60115, Indonesia
- Institute of Tropical Disease, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Junko Akada
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (P.S.); (D.D.); (K.A.F.); (J.A.); (T.M.); (L.A.W.); (V.P.T.)
| | - Takashi Matsumoto
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (P.S.); (D.D.); (K.A.F.); (J.A.); (T.M.); (L.A.W.); (V.P.T.)
| | - Than Than Yee
- Department of GI and HBP Surgery, No. (2) Defense Service General Hospital (1000 Bedded), Nay Pyi Taw 15013, Myanmar;
| | - Kyaw Htet
- Department of GI and HBP Surgery, No. (1) Defense Service General Hospital (1000 Bedded), Mingaladon, Yangon 11021, Myanmar;
| | - Langgeng Agung Waskito
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (P.S.); (D.D.); (K.A.F.); (J.A.); (T.M.); (L.A.W.); (V.P.T.)
- Department of Public Health and Preventive Medicine, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Vo Phuoc Tuan
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (P.S.); (D.D.); (K.A.F.); (J.A.); (T.M.); (L.A.W.); (V.P.T.)
- Department of Endoscopy, Cho Ray Hospital, Ho Chi Minh 749000, Vietnam
| | - Tomohisa Uchida
- Department of Molecular Pathology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan;
| | - Takeshi Matsuhisa
- Department of Gastroenterology, Nippon Medical School Tama Nagayama Hospital, Tama 206-8512, Japan;
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (P.S.); (D.D.); (K.A.F.); (J.A.); (T.M.); (L.A.W.); (V.P.T.)
- Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX 77030, USA
- Global Oita Medical Advanced Research Center for Health (GO-MARCH), Yufu 879-5593, Japan
- Correspondence: ; Tel.: +81-(97)-586-5740; Fax: +81-(97)-586-5749
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Chu A, Wang D, Guo Q, Lv Z, Yuan Y, Gong Y. Molecular detection of
H. pylori
antibiotic‐resistant genes and molecular docking analysis. FASEB J 2019; 34:610-618. [PMID: 31914672 DOI: 10.1096/fj.201900774r] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Aining Chu
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery the First Hospital of China Medical University Shenyang China
- Key Laboratory of Cancer Etiology and Prevention in Liaoning Education Department the First Hospital of China Medical University Shenyang China
- Key Laboratory of GI Cancer Etiology and Prevention in Liaoning Province the First Hospital of China Medical University Shenyang China
| | - Dan Wang
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery the First Hospital of China Medical University Shenyang China
- Key Laboratory of Cancer Etiology and Prevention in Liaoning Education Department the First Hospital of China Medical University Shenyang China
- Key Laboratory of GI Cancer Etiology and Prevention in Liaoning Province the First Hospital of China Medical University Shenyang China
| | - Qianqian Guo
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery the First Hospital of China Medical University Shenyang China
- Key Laboratory of Cancer Etiology and Prevention in Liaoning Education Department the First Hospital of China Medical University Shenyang China
- Key Laboratory of GI Cancer Etiology and Prevention in Liaoning Province the First Hospital of China Medical University Shenyang China
| | - Zhi Lv
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery the First Hospital of China Medical University Shenyang China
- Key Laboratory of Cancer Etiology and Prevention in Liaoning Education Department the First Hospital of China Medical University Shenyang China
- Key Laboratory of GI Cancer Etiology and Prevention in Liaoning Province the First Hospital of China Medical University Shenyang China
| | - Yuan Yuan
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery the First Hospital of China Medical University Shenyang China
- Key Laboratory of Cancer Etiology and Prevention in Liaoning Education Department the First Hospital of China Medical University Shenyang China
- Key Laboratory of GI Cancer Etiology and Prevention in Liaoning Province the First Hospital of China Medical University Shenyang China
| | - Yuehua Gong
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery the First Hospital of China Medical University Shenyang China
- Key Laboratory of Cancer Etiology and Prevention in Liaoning Education Department the First Hospital of China Medical University Shenyang China
- Key Laboratory of GI Cancer Etiology and Prevention in Liaoning Province the First Hospital of China Medical University Shenyang China
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Baroni MR, Bucci P, Giani RN, Giusti A, Tedeschi FA, Salvatierra E, Barbaglia Y, Jimenez F, Zalazar FE. Usefulness of rapid urease test samples for molecular analysis of clarithromycin resistance in Helicobacter pylori. Rev Argent Microbiol 2018; 50:359-364. [DOI: 10.1016/j.ram.2017.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/11/2017] [Accepted: 11/10/2017] [Indexed: 12/16/2022] Open
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Vianna JS, Ramis IB, Ramos DF, Gastal OL, Silva RAD, Gonçalves CV, Silva PEAD. The interplay between mutations in cagA, 23S rRNA, gyrA and drug resistance in Helicobacter pylori. Rev Inst Med Trop Sao Paulo 2018; 60:e25. [PMID: 29972462 PMCID: PMC6029892 DOI: 10.1590/s1678-9946201860025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/09/2018] [Indexed: 02/07/2023] Open
Abstract
In this study, we evaluated the mutations of Helicobacter pylori associated with resistance to clarithromycin and levofloxacin. Furthermore, based on the proposed interaction between antimicrobial resistance and pathogenicity, we correlated the mutation profiles of the strains with the presence of the pathogenicity gene cagA. We analyzed 80 gastric biopsy specimens from H. pylori-infected patients for point mutations in the 23S rRNA gene region and in the gyrA gene, which are related to clarithromycin and levofloxacin resistance, respectively, and investigated the presence of the cagA gene in these strains. We observed that in the assayed biopsies, 8.7% (7/80) had mutations in the 23S rRNA gene region at positions 2143 and 2142, while 22.5% (18/80) had mutations in gyrA at codons 87 and 91. Moreover, absence of the CagA-EPIYA pathogenicity factor was observed in 68% (17/25) of resistant samples. The knowledge of the local profile of antimicrobial resistance and the complex interplay involving resistance and pathogenicity can contribute to an appropriate clinical approach.
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Affiliation(s)
- Júlia Silveira Vianna
- Programa de Pós-Graduação em Biotecnologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Ivy Bastos Ramis
- Núcleo de Pesquisas em Microbiologia Médica, Universidade Federal de Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Daniela Fernandes Ramos
- Núcleo de Pesquisas em Microbiologia Médica, Universidade Federal de Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Otávio Leite Gastal
- Setor de Endoscopia Digestiva, Hospital Universitário São Francisco de Paula, Pelotas, Rio Grande do Sul, Brazil
| | - Renato Azevedo da Silva
- Setor de Endoscopia Digestiva, Hospital Universitário São Francisco de Paula, Pelotas, Rio Grande do Sul, Brazil
| | - Carla Vitola Gonçalves
- Núcleo de Pesquisas em Microbiologia Médica, Universidade Federal de Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
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COELHO LGV, MARINHO JR, GENTA R, RIBEIRO LT, PASSOS MDCF, ZATERKA S, ASSUMPÇÃO PP, BARBOSA AJA, BARBUTI R, BRAGA LL, BREYER H, CARVALHAES A, CHINZON D, CURY M, DOMINGUES G, JORGE JL, MAGUILNIK I, MARINHO FP, MORAES-FILHO JPD, PARENTE JML, PAULA-E-SILVA CMD, PEDRAZZOLI-JÚNIOR J, RAMOS AFP, SEIDLER H, SPINELLI JN, ZIR JV. IVTH BRAZILIAN CONSENSUS CONFERENCE ON HELICOBACTER PYLORI INFECTION. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55:97-121. [DOI: 10.1590/s0004-2803.201800000-20] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 02/06/2023]
Abstract
ABSTRACT Significant progress has been obtained since the III Brazilian Consensus Conference on H. pylori infection held in 2012, in Bento Gonçalves, Brazil, and justify a fourth meeting to establish updated guidelines on the current management of H. pylori infection. Therefore, the Núcleo Brasileiro para Estudo do Helicobacter pylori e Microbiota (NBEHPM), association linked to Brazilian Federation of Gastroenterology (FBG) held its fourth meeting again in Bento Gonçalves, RS, Brazil, on August 25-27, 2017. Twenty-six delegates, including gastroenterologists, endoscopists, and pathologists from the five regions of Brazil as well as one international guest from the United States, participated in the meeting. The participants were invited based on their knowledge and contribution to the study of H. pylori infection. The meeting sought to review different aspects of treatment for infection; establish a correlation between infection, dyspepsia, intestinal microbiota changes, and other disorders with a special emphasis on gastric cancer; and reassess the epidemiological and diagnostic aspects of H. pylori infection. Participants were allocated into four groups as follows: 1) Epidemiology and Diagnosis, 2) Dyspepsia, intestinal microbiota and other afections, 3) Gastric Cancer, and, 4) Treatment. Before the consensus meeting, participants received a topic to be discussed and prepared a document containing a recent literature review and statements that should be discussed and eventually modified during the face-to-face meeting. All statements were evaluated in two rounds of voting. Initially, each participant discussed the document and statements with his group for possible modifications and voting. Subsequently, during a second voting in a plenary session in the presence of all participants, the statements were voted upon and eventually modified. The participants could vote using five alternatives: 1) strongly agree; 2) partially agree; 3) undecided; 4) disagree; and 5) strongly disagree. The adopted consensus index was that 80% of the participants responded that they strongly or partially agreed with each statement. The recommendations reported are intended to provide the most current and relevant evidences to management of H. pylori infection in adult population in Brazil.
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6
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Gong Y, Yuan Y. Resistance mechanisms of Helicobacter pylori and its dual target precise therapy. Crit Rev Microbiol 2018; 44:371-392. [PMID: 29293032 DOI: 10.1080/1040841x.2017.1418285] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Helicobacter pylori drug resistance presents a significant challenge to the successful eradication of this pathogen. To find strategies to improve the eradication efficacy of H. pylori, it is necessary to clarify the resistance mechanisms involved. The mechanisms of H. pylori drug resistance can be investigated from two angles: the pathogen and the host. A comprehensive understanding of the molecular mechanisms of H. pylori resistance based on both pathogen and host would aid the implementation of precise therapy, or ideally "dual target precise therapy" (bacteria and host-specific target therapy). In recent years, with increased understanding of the mechanisms of H. pylori resistance, the focus of eradication has shifted from disease-specific to patient-specific treatment. The implementation of "precision medicine" has also provided a new perspective on the treatment of infectious diseases. In this article, we systematically review current research on H. pylori drug resistance from the perspective of both the pathogen and the host. We also review therapeutic strategies targeted to pathogen and host factors that are aimed at achieving precise treatment of H. pylori.
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Affiliation(s)
- Yuehua Gong
- a Tumor Etiology and Screening Department of Cancer Institute and General Surgery , the First Hospital of China Medical University , Shenyang , China.,b Key Laboratory of Cancer Etiology and Prevention (China Medical University) Liaoning Provincial Education Department , Shenyang , China.,c National Clinical Research Center for Digestive Diseases , Xi'an , China
| | - Yuan Yuan
- a Tumor Etiology and Screening Department of Cancer Institute and General Surgery , the First Hospital of China Medical University , Shenyang , China.,b Key Laboratory of Cancer Etiology and Prevention (China Medical University) Liaoning Provincial Education Department , Shenyang , China.,c National Clinical Research Center for Digestive Diseases , Xi'an , China
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7
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Miftahussurur M, Cruz M, Subsomwong P, Jiménez Abreu JA, Hosking C, Nagashima H, Akada J, Yamaoka Y. Clarithromycin-Based Triple Therapy is Still Useful as an Initial Treatment for Helicobacter pylori Infection in the Dominican Republic. Am J Trop Med Hyg 2017; 96:1050-1059. [PMID: 28193745 DOI: 10.4269/ajtmh.16-0729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AbstractHelicobacter pylori antibiotic susceptibility in the Dominican Republic has not been monitored. We assessed H. pylori antibiotic susceptibility in the Dominican Republic, and analyzed H. pylori mutations associated with antibiotic resistance. We recruited 158 dyspeptic patients in Santo Domingo and used agar dilution to test susceptibility to five antibiotics. Polymerase chain reaction-based sequencing was used to assess gyrA, gyrB, rdxA, frxA, and 23S rRNA mutations; next-generation sequencing was used to identify other metronidazole resistance-associated genes. Among 64 H. pylori strains isolated, we identified two (3.1%), one (1.6%), and no strains with clarithromycin, amoxicillin, and tetracycline resistance, respectively. Moreover, high frequency of metronidazole resistance (53/64, 82.8%) was observed, whereas levofloxacin resistance is emerging (23/64, 35.9%). We identified many rdxA and frxA mutations in metronidazole-resistant strains, but no synergistic effect was apparent. We revealed novel mutations in dppA, dppB, fdxA, and fdxB, irrespective of rdxA and frxA mutations. Novel mutations at Ser-14 of trx1 and Arg-221 of dapF were associated with different levels of metronidazole resistance. Most levofloxacin-resistant strains had a substitution at Asn-87 of gyrA, including the strain with the highest levofloxacin resistance, whereas only three substitutions were found at Ser-479 of gyrB with no synergistic effect. Besides the 23S rRNA A2142G mutation, we observed another mutation at T1958G in both clarithromycin-resistant strains. We confirmed high metronidazole and levofloxacin resistance associated with genetic mutations in the Dominican Republic. However, prevalence of clarithromycin resistance was low, suggesting that standard clarithromycin-based triple therapy remains useful as initial treatment of H. pylori infection.
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Affiliation(s)
- Muhammad Miftahussurur
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan.,Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas.,Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital-Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Modesto Cruz
- Institute of Microbiology and Parasitology, Faculty of Science, Autonomous University of Santo Domingo, Santo Domingo, Dominican Republic.,Department of Biomedical Research, National Institute of Medicine and Diagnostic Imaging, Santo Domingo, Dominican Republic
| | - Phawinee Subsomwong
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - José A Jiménez Abreu
- Dominican-Japanese Digestive Disease Center, Dr. Luis E. Aybar Health and Hygiene City, Santo Domingo, Dominican Republic
| | - Celso Hosking
- Institute of Microbiology and Parasitology, Faculty of Science, Autonomous University of Santo Domingo, Santo Domingo, Dominican Republic
| | - Hiroyuki Nagashima
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - Junko Akada
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan.,Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas
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8
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Martins GM, Sanches BSF, Moretzsohn LD, Lima KS, Cota BDCV, Coelho LGV. MOLECULAR DETECTION OF CLARITHROMYCIN AND FLUOROQUINOLONES RESISTANCE IN HELICOBACTER PYLORI INFECTION, DIRECTLY APPLIED TO GASTRIC BIOPSIES, IN AN URBAN BRAZILIAN POPULATION. ARQUIVOS DE GASTROENTEROLOGIA 2017; 53:113-7. [PMID: 27305419 DOI: 10.1590/s0004-28032016000200012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/01/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND - Antimicrobial resistance is the major factor leading to eradication failure in H. pylori treatment. Molecular tests are useful to detect genetic mutations predictive of clarithromycin and fluoroquinolones resistance. Knowledge of the local prevalence rate of resistance is important to define the best recommended treatment. OBJECTIVE - To assess the prevalence of primary resistance of H. pylori to clarithromycin and fluoroquinolones, using a molecular test, in a Southeastern urban Brazilian population. METHODS - A total of 72 H. pylori seropositive patients [65% female, mean age 39 (19-73) years] never treated before for this infection were studied. All patients underwent gastroscopy in addition to antrum and corpus biopsies and molecular test GenoType HelicoDR (Hain Life Science, Germany) to detect H. pylori and point mutations in genes responsible for clarithromycin and fluoroquinolone resistance. The molecular procedure was divided into three steps: DNA extraction from biopsy samples, a multiplex amplification with biotinylated primers and a reverse hybridization. The most frequent point mutations involved in resistance to the two antibiotics were evaluated. RESULTS - Resistance to clarithromycin was detected in nine (12.5%) patients and to fluoroquinolones in eight (11.1%) patients. The point mutation A2147G was the most common (77.8%) among resistant strains to clarithromycin. In 50% of the resistant strains to fluoroquinolones, the mutant codon couldn't be identified. CONCLUSION - The resistance rates to clarithromycin and fluorquinolones in a large urban population in the Southeast of Brazil were acceptable, suggesting that these drugs remain appropriate options to first and second-line of H. pylori treatment. The molecular test represents an adequate diagnostic tool for monitoring H. pylori resistance.
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Affiliation(s)
- Gustavo Miranda Martins
- Universidade Federal de Minas Gerais, Instituto Alfa de Gastroenterologia, Belo Horizonte, MG, Brasil., Universidade Federal de Minas Gerais, Universidade Federal de Minas Gerais, Instituto Alfa de Gastroenterologia, Belo Horizonte MG , Brazil
| | - Bruno Squárcio Fernandes Sanches
- Universidade Federal de Minas Gerais, Instituto Alfa de Gastroenterologia, Belo Horizonte, MG, Brasil., Universidade Federal de Minas Gerais, Universidade Federal de Minas Gerais, Instituto Alfa de Gastroenterologia, Belo Horizonte MG , Brazil
| | - Luciana Dias Moretzsohn
- Universidade Federal de Minas Gerais, Instituto Alfa de Gastroenterologia, Belo Horizonte, MG, Brasil., Universidade Federal de Minas Gerais, Universidade Federal de Minas Gerais, Instituto Alfa de Gastroenterologia, Belo Horizonte MG , Brazil
| | - Karine Sampaio Lima
- Universidade Federal de Minas Gerais, Instituto Alfa de Gastroenterologia, Belo Horizonte, MG, Brasil., Universidade Federal de Minas Gerais, Universidade Federal de Minas Gerais, Instituto Alfa de Gastroenterologia, Belo Horizonte MG , Brazil
| | - Bianca Della Croce V Cota
- Universidade Federal de Minas Gerais, Instituto Alfa de Gastroenterologia, Belo Horizonte, MG, Brasil., Universidade Federal de Minas Gerais, Universidade Federal de Minas Gerais, Instituto Alfa de Gastroenterologia, Belo Horizonte MG , Brazil
| | - Luiz Gonzaga Vaz Coelho
- Universidade Federal de Minas Gerais, Instituto Alfa de Gastroenterologia, Belo Horizonte, MG, Brasil., Universidade Federal de Minas Gerais, Universidade Federal de Minas Gerais, Instituto Alfa de Gastroenterologia, Belo Horizonte MG , Brazil
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Ramzy I, Elgarem H, Hamza I, Ghaith D, Elbaz T, Elhosary W, Mostafa G, Elzahry MAME. GENETIC MUTATIONS AFFECTING THE FIRST LINE ERADICATION THERAPY OF Helicobacter pylori-INFECTED EGYPTIAN PATIENTS. Rev Inst Med Trop Sao Paulo 2016; 58:88. [PMID: 27982354 PMCID: PMC5147718 DOI: 10.1590/s1678-9946201658088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/28/2016] [Indexed: 12/23/2022] Open
Abstract
Introduction: Several genetic mutations affect the first-line triple therapy for
Helicobacter pylori. We aimed to study the most common genetic
mutations affecting the metronidazole and clarithromycin therapy for
H. pylori-infected Egyptian patients. Patients and Methods: In our study, we included 100 successive dyspeptic patients scheduled for
diagnosis through upper gastroscopy at Cairo's University Hospital, Egypt. Gastric
biopsies were tested for the presence of H. pylori by detection
of the 16S rRNA gene. Positive biopsies were further studied for
the presence of the rdxA gene deletion by Polymerase Chain
Reaction (PCR), while clarithromycin resistance was investigated by the presence
of nucleotide substitutions within H. pylori 23S rRNA V domain
using MboII and BsaI to carry out a Restricted
Fragment Length Polymorphism (RFLP) assay. Results: Among 70 H. pylori positive biopsies, the rdxA
gene deletion was detected in 44/70 (62.9%) samples, while predominance of the
A2142G mutations within the H. pylori 23S rRNA V domain was
evidenced in 39/70 (55.7%) of the positive H. pylori cases. No
statistically significant difference was found between the presence of gene
mutations and different factors such as patients 'age, gender, geographic
distribution, symptoms and endoscopic findings. Conclusion: Infection with mutated H. pylori strains is considerably high, a
finding that imposes care in the use of the triple therapy to treat H.
pylori in Egypt, since the guidelines recommend to abandon the
standard triple therapy when the primary clarithromycin resistance rate is over
20%1.
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Affiliation(s)
- Iman Ramzy
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt. E-mails: ; ; ; ; ; ;
| | - Hassan Elgarem
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt. E-mails: ; ; ; ; ; ;
| | - Iman Hamza
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt. E-mails: ; ; ; ; ; ;
| | - Doaa Ghaith
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt. E-mail:
| | - Tamer Elbaz
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt. E-mails: ; ; ; ; ; ;
| | - Waleed Elhosary
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt. E-mails: ; ; ; ; ; ;
| | - Gehan Mostafa
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt. E-mails: ; ; ; ; ; ;
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Miftahussurur M, Shrestha PK, Subsomwong P, Sharma RP, Yamaoka Y. Emerging Helicobacter pylori levofloxacin resistance and novel genetic mutation in Nepal. BMC Microbiol 2016; 16:256. [PMID: 27809767 PMCID: PMC5096319 DOI: 10.1186/s12866-016-0873-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 10/27/2016] [Indexed: 01/06/2023] Open
Abstract
Background The prevalence of Helicobacter pylori antibiotic susceptibility in the Nepalese strains is untracked. We determined the antibiotic susceptibility for H. pylori and analyzed the presence of genetic mutations associated with antibiotic resistance in Nepalese strains. Results This study included 146 consecutive patients who underwent gastroduodenal endoscopy in Kathmandu, Nepal. Among 42 isolated H. pylori, there was no resistance to amoxicillin and tetracycline. In contrast, similar with typical South Asian patterns; metronidazole resistance rate in Nepalese strains were extremely high (88.1 %, 37/42). Clarithromycin resistance rate in Nepalese strains were modestly high (21.4 %, 9/42). Most of metronidazole resistant strains had highly distributed rdxA and frxA mutations, but were relative coincidence without a synergistic effect to increase the minimum inhibitory concentration (MIC). Among strains with the high MIC, 63.6 % (7/11) were associated with frameshift mutation at position 18 of frxA with or without rdxA involvement. However, based on next generation sequencing data we found that one strain with the highest MIC value had a novel mutation in the form of amino acid substituted at Ala-212, Gln-382, Ile-485 of dppA and Leu-145, Thr-168, Glu-117, Val-121, Arg-221 in dapF aside from missense mutations in full-length rdxA. Mutations at Asn-87 and/or Asp-91 of the gyrA were predominantly in levofloxacin-resistant strains. The gyrB mutation had steady relationship with the gyrA 87–91 mutations. Although three (44.4 %) and two (22.2 %) of clarithromycin resistant strains had point mutation on A2143G and A2146G, we confirmed the involvement of rpl22 and infB in high MIC strains without an 23SrRNA mutation. Conclusions The rates of resistance to clarithromycin, metronidazole and levofloxacin were high in Nepalese strains, indicating that these antibiotics-based triple therapies are not useful as first-line treatment in Nepal. Bismuth or non-bismuth-based quadruple regimens, furazolidone-based triple therapy or rifabutin-based triple therapy may become alternative strategy in Nepal. Electronic supplementary material The online version of this article (doi:10.1186/s12866-016-0873-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Muhammad Miftahussurur
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-City, Oita, 879-5593, Japan.,Department of Gastroenterology and Hepatology, Baylor College of Medicine and Michael DeBakey Veterans Affairs Medical Center, Houston, TX, 77030, USA.,Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine-Institute of Tropical Disease, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Pradeep Krishna Shrestha
- Gastroenterology Department, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, 44600, Nepal
| | - Phawinee Subsomwong
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-City, Oita, 879-5593, Japan
| | - Rabi Prakash Sharma
- Gastroenterology Department, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, 44600, Nepal
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-City, Oita, 879-5593, Japan. .,Department of Gastroenterology and Hepatology, Baylor College of Medicine and Michael DeBakey Veterans Affairs Medical Center, Houston, TX, 77030, USA.
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Khashei R, Dara M, Bazargani A, Bagheri Lankarani K, Taghavi A, Moeini M, Dehghani B, Sohrabi M. High rate of A2142G point mutation associated with clarithromycin resistance among Iranian Helicobacter pylori clinical isolates. APMIS 2016; 124:787-93. [PMID: 27357065 DOI: 10.1111/apm.12567] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 05/13/2016] [Indexed: 02/05/2023]
Abstract
This study aimed to investigate the clarithromycin resistance and its associated molecular mechanisms among Helicobacter pylori isolates from dyspeptic patients in Shiraz, Iran. From January to May 2014, 100 H. pylori strains were isolated from patients with gastroduodenal disorders. The resistance to clarithromycin was quantitatively evaluated, using Epsilometer (E-test) method. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was performed on all the isolates to detect A2143G and A2142G mutations in 23S rRNA gene. The H. pylori isolation rate was found to be 31.4%. E-test showed that 20% of isolates were resistant to clarithromycin (MIC ≥ 1 mg/L). MIC of clarithromycin ranged between 0.016 and 24 mg/L. Findings of PCR-RFLP showed that the A2142G was the most (90%) frequently point mutation, followed by the A2143G (10%). No statistically significant difference was found between H. pylori clarithromycin resistance point mutations and patients' gender or age. To the best of our knowledge, this is the first report of high frequency of A2142G point mutation in Iran and probably in other regions of the world. Considering the increasing trend of H. pylori resistance to clarithromycin due to these mutations, it is crucial to investigate the new therapeutic approaches against H. pylori infection.
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Affiliation(s)
- Reza Khashei
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahintaj Dara
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdollah Bazargani
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Bagheri Lankarani
- Department of Internal Medicine, Gastroenterology Ward, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Taghavi
- Department of Internal Medicine, Gastroenterology Ward, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Moeini
- Department of Internal Medicine, Gastroenterology Ward, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behzad Dehghani
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Sohrabi
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Ghaith D, Elzahry M, Mostafa G, Mostafa S, Elsherif R, Ramzy I. Mutations affecting domain V of the 23S rRNA gene in Helicobacter pylori from Cairo, Egypt. J Chemother 2016; 28:367-70. [PMID: 26358218 DOI: 10.1179/1973947815y.0000000067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Clarithromycin is a main component of the recommended first-line triple therapy for Helicobacter pylori in Egypt. We aimed in our study to investigate the prevalence of clarithromycin-resistant H. pylori strains due to the point mutations at domain V of the H. pylori 23S rRNA among the Egyptian population using the polymerase chain reaction/restricted fragment length polymorphism (PCR/RFLP) assay. METHODS Gastric biopsies obtained from 100 dyspeptic patients who consecutively attended at Cairo University Hospital during the period from January to November 2013 were subjected to PCR/RFLP in order to detect the point mutations at domain V of the H. pylori 23S rRNA associated with clarithromycin resistance. The PCR amplicon of the 23S H. pylori rRNA is restricted with MboII for detection of A2142G mutation and with BsaI for A2143G mutation. RESULTS The prevalence of H. pylori infection among 100 patients was 70%; clarithromycin resistance was detected in 39/70 (57.7%) of positive H. pylori isolates. Occurrence of 23S rRNA A2142G mutations resulted in two DNA fragments (418 and 350 bp) by PCR-RFLP; on the other hand, no A2143G mutations were detected. CONCLUSIONS The high prevalence of clarithromycin resistance (57.7%) caused by A2142G mutations at domain V of the H. pylori 23S rRNA may mandate changing of the standard clarithromycin-containing triple therapy. The PCR/RFLP assay was a rapid and accurate method for molecular detection of H. pylori infection in addition to determination of different nucleotide mutations causing clarithromycin resistance.
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Affiliation(s)
- Doaa Ghaith
- a Clinical and Chemical Pathology Department, Faculty of Medicine , Cairo University , Egypt
| | - Mohammad Elzahry
- b Endemic Medicine and Hepatology Department, Faculty of Medicine , Cairo University , Egypt
| | - Gehan Mostafa
- b Endemic Medicine and Hepatology Department, Faculty of Medicine , Cairo University , Egypt
| | - Sally Mostafa
- c Clinical and Chemical Pathology Department, Faculty of Medicine , Beni-Suef University , Egypt
| | - Rasha Elsherif
- a Clinical and Chemical Pathology Department, Faculty of Medicine , Cairo University , Egypt
| | - Iman Ramzy
- b Endemic Medicine and Hepatology Department, Faculty of Medicine , Cairo University , Egypt
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Alarcón-Millán J, Fernández-Tilapa G, Cortés-Malagón EM, Castañón-Sánchez CA, De Sampedro-Reyes J, Cruz-Del Carmen I, Betancourt-Linares R, Román-Román A. Clarithromycin resistance and prevalence of Helicobacter pylori virulent genotypes in patients from Southern México with chronic gastritis. INFECTION GENETICS AND EVOLUTION 2016; 44:190-198. [PMID: 27355861 DOI: 10.1016/j.meegid.2016.06.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 02/07/2023]
Abstract
In developing countries, clarithromycin resistance and frequency of re-infection are factors that contribute to high prevalence of Helicobacter pylori infection. The aim of this research was determine the prevalence of clarithromycin resistance and its relation with A2142G, A2142C and A2143G mutations in the domain V of the 23S rRNA gene of H. pylori isolates in patients from Southern Mexico with chronic gastritis. Another purpose of this work was to study the prevalence of virulent genotypes and distribution of resistant strains according to the vacA/cagA/babA2 H. pylori genotypes. One hundred forty-four patients with chronic gastritis were studied. Forty-five H. pylori strains were isolated and clarithromycin susceptibility was determined by the disk-diffusion method. The 82.2% of the strains had the combination of alleles vacA s1 m1 and the cagA gene was detected in 77.8% and 40% of the strains were babA2 positive. The vacA s1 m1 genotype was detected more frequently in cagA(+) strains, vacA s1m1/cagA(+)/babA2(-) genotype was more frequent than vacA s1m1/cagA(+)/babA2(+), 37.8% and 33.3%, respectively. Eight strains were clarithromycin resistant, in three of these, point mutations were identified, but only in one strain the A2143G mutation associated with clarithromycin resistance was found. Other point mutations (A1821G, G1826A, T1830C, A2089G, T1600C, C1601T, C1602T, T1610C, A1611C and T1633G) that have not been associated with clarithromycin resistance were identified. The highest proportion of resistant strains was vacA s1m1/cagA(+) (62.5%). In patients from southern Mexico with chronic gastritis, the prevalence of clarithromycin resistance is within internationally accepted range (17.8%) and allows continued use of triple therapy for H. pylori eradication. However, it is necessary to monitor the evolution of clarithromycin resistance in this area. The largest proportion of resistant H. pylori strains is not harboring the A2142G, A2142C and A2143G mutations in the 23S rRNA gene (87.5%). The vacA s1m1/cagA(+) genotype was the most prevalent and among clarithromycin-resistant strains, this was the predominant.
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Affiliation(s)
- Judit Alarcón-Millán
- Laboratorio de Investigación en Bacteriología, Unidad Académica de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, México.
| | - Gloria Fernández-Tilapa
- Laboratorio de Investigación Clínica, Unidad Académica de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, México.
| | - Enoc Mariano Cortés-Malagón
- Laboratorio de Biología Molecular del Cáncer, Unidad de Investigación, Hospital Juárez de México, Ciudad de México, México.
| | | | | | - Iván Cruz-Del Carmen
- Hospital General "Dr. Raymundo Abarca Alarcón", Chilpancingo, Guerrero, México; Unidad Especializada de Gastroenterología Endoscopia, Chilpancingo, Guerrero, México.
| | | | - Adolfo Román-Román
- Laboratorio de Investigación en Bacteriología, Unidad Académica de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, México.
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Caliskan R, Tokman HB, Erzin Y, Saribas S, Yuksel P, Bolek BK, Sevuk EO, Demirci M, Yılmazli O, Akgul O, Kalayci F, Cakan H, Salih B, Bal K, Kocazeybek B. Antimicrobial resistance of Helicobacter pylori strains to five antibiotics, including levofloxacin, in Northwestern Turkey. Rev Soc Bras Med Trop 2016; 48:278-84. [PMID: 26108005 DOI: 10.1590/0037-8682-0027-2015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/24/2015] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Antibiotic resistance is the main factor that affects the efficacy of current therapeutic regimens against Helicobacter pylori. This study aimed to determine the rates of resistance to efficacy clarithromycin, amoxicillin, tetracycline, levofloxacin and metronidazole among H. pylori strains isolated from Turkish patients with dyspepsia. METHODS H. pylori was cultured from corpus and antrum biopsies that were collected from patients with dyspeptic symptoms, and the antimicrobial susceptibility of H. pylori was determined using the E-test (clarithromycin, amoxicillin, tetracycline, metronidazole and levofloxacin) according to the EUCAST breakpoints. Point mutations in the 23S rRNA gene of clarithromycin-resistant strains were investigated using real-time PCR. RESULTS A total of 98 H. pylori strains were isolated, all of which were susceptible to amoxicillin and tetracycline. Of these strains, 36.7% (36/98) were resistant to clarithromycin, 35.5% (34/98) were resistant to metronidazole, and 29.5% (29/98) were resistant to levofloxacin. Multiple resistance was detected in 19.3% of the isolates. The A2143G and A2144G point mutations in the 23S rRNA-encoding gene were found in all 36 (100%) of the clarithromycin-resistant strains. Additionally, the levofloxacin MIC values increased to 32 mg/L in our H. pylori strains. Finally, among the clarithromycin-resistant strains, 27.2% were resistant to levofloxacin, and 45.4% were resistant to metronidazole. CONCLUSIONS We conclude that treatment failure after clarithromycin- or levofloxacin-based triple therapy is not surprising and that metronidazole is not a reliable agent for the eradication of H. pylori infection in Turkey.
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Affiliation(s)
- Reyhan Caliskan
- Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul University, Istanbul, Turkey
| | - Hrisi Bahar Tokman
- Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul University, Istanbul, Turkey
| | - Yusuf Erzin
- Cerrahpasa Faculty of Medicine, Department of Gastroenterology, Istanbul University, Istanbul, Turkey
| | - Suat Saribas
- Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul University, Istanbul, Turkey
| | - Pelin Yuksel
- Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul University, Istanbul, Turkey
| | - Bora Kazim Bolek
- Medical Laboratory Techniques Program, Vocational School of Health Services, Istanbul Esenyurt University, Istanbul, Turkey
| | - Ecehan Ozge Sevuk
- Faculty of Arts and Sciences, Department of Biology, Fatih University, Istanbul, Turkey
| | - Mehmet Demirci
- Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul University, Istanbul, Turkey
| | - Ozge Yılmazli
- Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul University, Istanbul, Turkey
| | - Ozer Akgul
- Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul University, Istanbul, Turkey
| | - Fatma Kalayci
- Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul University, Istanbul, Turkey
| | - Huseyin Cakan
- Institute of Forensic Sciences,, Department of Microbiology, Istanbul University, Istanbul, Turkey
| | - Barik Salih
- Faculty of Arts and Sciencs, Department of Biology, Fatih University, Istanbul, Turkey
| | - Kadir Bal
- Cerrahpasa Faculty of Medicine, Department of Gastroenterology, Istanbul University, Istanbul, Turkey
| | - Bekir Kocazeybek
- Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul University, Istanbul, Turkey
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Ruer S, Pinotsis N, Steadman D, Waksman G, Remaut H. Virulence-targeted Antibacterials: Concept, Promise, and Susceptibility to Resistance Mechanisms. Chem Biol Drug Des 2015; 86:379-99. [DOI: 10.1111/cbdd.12517] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/23/2014] [Accepted: 01/06/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Ségolène Ruer
- Structural and Molecular Microbiology; Structural Biology Research Center; VIB; Pleinlaan 2 Brussels 1050 Belgium
- Structural Biology Brussels; Vrije Universiteit Brussel; Pleinlaan 2 Brussels 1050 Belgium
| | - Nikos Pinotsis
- Institute of Structural and Molecular Biology (ISMB); UCL and Birkbeck College; London WC1E 7HX UK
| | - David Steadman
- Wolfson Institute for Biomedical Research (WIBR); UCL; London WC1E 6BT UK
| | - Gabriel Waksman
- Institute of Structural and Molecular Biology (ISMB); UCL and Birkbeck College; London WC1E 7HX UK
| | - Han Remaut
- Structural and Molecular Microbiology; Structural Biology Research Center; VIB; Pleinlaan 2 Brussels 1050 Belgium
- Structural Biology Brussels; Vrije Universiteit Brussel; Pleinlaan 2 Brussels 1050 Belgium
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Abstract
This review summarizes important studies regarding H.pylori therapy published from April 2013 to April 2014. The main themes that emerge are assessing the efficacy of standard triple therapy, as well as exploring new first-line treatments, predominantly optimized triple therapies and non-bismuth quadruple schemes. Regarding newer non-bismuth quadruple regimens, the compliance and tolerance seem to be similar for sequential and concomitant regimens. Notably, no study yet has demonstrated a clear statistical superiority for either, and a systematic review and meta-analysis may be warranted. Other studies examined the role of levofloxacin and bismuth based therapies in H. pylori eradication. The efficacy of bismuth as a second-line after sequential therapy was particularly noteworthy. Levofloxacin-based therapies also appear to be useful and versatile as part of different antibiotic combinations and in first-, second-, and third-line therapies. The emerging problem of quinolone resistance remains a worry. Individualized therapy, based on factors such as antimicrobial information, resistance data, and CYP2C19 metabolism, may well be the most notable future trend to emerge this year.
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Affiliation(s)
- Anthony O'Connor
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
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