Recent Trends ofHelicobacter pyloriEradication Therapy in Korea

Concomitant or Sequential Therapy as the First-line Therapy for Eradication of Helicobacter pylori Infection in Korea: A Systematic Review and Meta-analysis

BACKGROUND/AIMS

In Korea, increasing clarithromycin resistance has led to the need for an alternative first-line therapy for the eradication of Helicobacter pylori (H. pylori) infection. Concomitant therapy (CT) and sequential therapy (ST) have been proposed as alternative regimens. The aim of this study was to compare the eradication rate from using CT and ST in Korea.

METHODS

A literature review was performed on studies comparing the efficacy of CT and ST in Korea. Data were pooled to obtain the odds ratio (OR) of the eradication rate with 95% confidence intervals (CIs). The eradication rates were considered both on an intention-to-treat (ITT) and a per-protocol (PP) bases.

RESULTS

Six studies provided data on 1,897 Korean adult patients. The pooled OR was 1.382 (95% CI: 1.031-1.853, p=0.031) for ITT analysis and 2.114 (95% CI: 1.502-2.974, p<0.001) for PP analysis. There was no difference in the rate of adverse events and compliances between the two regimens.

CONCLUSIONS

The efficacy of CT was superior to ST in both ITT and PP analyses. Therefore, CT could be an excellent alternative regimen for the eradication of H. pylori as a first-line therapy in Korea.

Review article: the global emergence of Helicobacter pylori antibiotic resistance

BACKGROUND

Helicobacter pylori is one of the most prevalent global pathogens and can lead to gastrointestinal disease including peptic ulcers, gastric marginal zone lymphoma and gastric carcinoma.

AIM

To review recent trends in H. pylori antibiotic resistance rates, and to discuss diagnostics and treatment paradigms.

METHODS

A PubMed literature search using the following keywords: Helicobacter pylori, antibiotic resistance, clarithromycin, levofloxacin, metronidazole, prevalence, susceptibility testing.

RESULTS

The prevalence of bacterial antibiotic resistance is regionally variable and appears to be markedly increasing with time in many countries. Concordantly, the antimicrobial eradication rate of H. pylori has been declining globally. In particular, clarithromycin resistance has been rapidly increasing in many countries over the past decade, with rates as high as approximately 30% in Japan and Italy, 50% in China and 40% in Turkey; whereas resistance rates are much lower in Sweden and Taiwan, at approximately 15%; there are limited data in the USA. Other antibiotics show similar trends, although less pronounced.

CONCLUSIONS

Since the choice of empiric therapies should be predicated on accurate information regarding antibiotic resistance rates, there is a critical need for determination of current rates at a local scale, and perhaps in individual patients. Such information would not only guide selection of appropriate empiric antibiotic therapy but also inform the development of better methods to identify H. pylori antibiotic resistance at diagnosis. Patient-specific tailoring of effective antibiotic treatment strategies may lead to reduced treatment failures and less antibiotic resistance.