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. 1992 Jan;36(1):163–166. doi: 10.1128/aac.36.1.163

Role of metronidazole resistance in therapy of Helicobacter pylori infections.

H Rautelin 1, K Seppälä 1, O V Renkonen 1, U Vainio 1, T U Kosunen 1
PMCID: PMC189246  PMID: 1590683

Abstract

Susceptibility to metronidazole was determined by disk diffusion tests for 559 strains of Helicobacter pylori isolated from patients. The overall metronidazole resistance was 26%. In males metronidazole-resistant strains made 18% of all H. pylori strains, and in females the corresponding figure was 40% (P less than 0.001). MICs of metronidazole were determined for H. pylori strains from 86 patients undertaking triple therapy, i.e., treatment with colloidal bismuth subcitrate, amoxicillin, and metronidazole. Of the nonresponders who remained culture positive despite the therapy, 69% had strains with metronidazole MICs of greater than or equal to 32 micrograms/ml before the therapy, and all nonresponders had metronidazole-resistant strains after the therapy. Metronidazole resistance was, however, also found in 27% of responders before therapy. To find whether the MICs of metronidazole for H. pylori strains remained constant for longer periods, consecutive isolates sampled several years apart from the same patients were tested in parallel and no changes in the MICs were found. H. pylori was successfully eradicated by the triple therapy from 91% of patients with metronidazole-susceptible pretreatment strains and from 63% of patients with metronidazole-resistant strains before the therapy (P less than 0.01). Although resistance to metronidazole has a significant role in treatment failures in H. pylori infections, high eradication rates can be achieved with the use of the present triple therapy even in populations with a high overall metronidazole resistance rate.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Becx M. C., Janssen A. J., Clasener H. A., de Koning R. W. Metronidazole-resistant Helicobacter pylori. Lancet. 1990 Mar 3;335(8688):539–540. doi: 10.1016/0140-6736(90)90772-w. [DOI] [PubMed] [Google Scholar]
  2. Glupczynski Y., Burette A., De Koster E., Nyst J. F., Deltenre M., Cadranel S., Bourdeaux L., De Vos D. Metronidazole resistance in Helicobacter pylori. Lancet. 1990 Apr 21;335(8695):976–977. doi: 10.1016/0140-6736(90)91043-a. [DOI] [PubMed] [Google Scholar]
  3. Glupczynski Y., Labbe M., Burette A., Delmee M., Avesani V., Bruck C. Treatment failure of ofloxacin in Campylobacter pylori infection. Lancet. 1987 May 9;1(8541):1096–1096. doi: 10.1016/s0140-6736(87)90527-7. [DOI] [PubMed] [Google Scholar]
  4. Goodwin C. S., Blake P., Blincow E. The minimum inhibitory and bactericidal concentrations of antibiotics and anti-ulcer agents against Campylobacter pyloridis. J Antimicrob Chemother. 1986 Mar;17(3):309–314. doi: 10.1093/jac/17.3.309. [DOI] [PubMed] [Google Scholar]
  5. Goodwin C. S., Marshall B. J., Blincow E. D., Wilson D. H., Blackbourn S., Phillips M. Prevention of nitroimidazole resistance in Campylobacter pylori by coadministration of colloidal bismuth subcitrate: clinical and in vitro studies. J Clin Pathol. 1988 Feb;41(2):207–210. doi: 10.1136/jcp.41.2.207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Haas C. E., Nix D. E., Schentag J. J. In vitro selection of resistant Helicobacter pylori. Antimicrob Agents Chemother. 1990 Sep;34(9):1637–1641. doi: 10.1128/aac.34.9.1637. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Lane M. R., Lee S. P. Recurrence of duodenal ulcer after medical treatment. Lancet. 1988 May 21;1(8595):1147–1149. doi: 10.1016/s0140-6736(88)91961-7. [DOI] [PubMed] [Google Scholar]
  8. Marshall B. J., Armstrong J. A., McGechie D. B., Glancy R. J. Attempt to fulfil Koch's postulates for pyloric Campylobacter. Med J Aust. 1985 Apr 15;142(8):436–439. doi: 10.5694/j.1326-5377.1985.tb113443.x. [DOI] [PubMed] [Google Scholar]
  9. McNulty C. A., Dent J. C. Susceptibility of clinical isolates of Campylobacter pylori to twenty-one antimicrobial agents. Eur J Clin Microbiol Infect Dis. 1988 Aug;7(4):566–569. doi: 10.1007/BF01962617. [DOI] [PubMed] [Google Scholar]
  10. McNulty C. A., Gearty J. C., Crump B., Davis M., Donovan I. A., Melikian V., Lister D. M., Wise R. Campylobacter pyloridis and associated gastritis: investigator blind, placebo controlled trial of bismuth salicylate and erythromycin ethylsuccinate. Br Med J (Clin Res Ed) 1986 Sep 13;293(6548):645–649. doi: 10.1136/bmj.293.6548.645. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Mertens J. C., Dekker W., Ligtvoet E. E., Blok P. Treatment failure of norfloxacin against Campylobacter pylori and chronic gastritis in patients with nonulcerative dyspepsia. Antimicrob Agents Chemother. 1989 Feb;33(2):256–257. doi: 10.1128/aac.33.2.256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Morgan D., Kraft W., Bender M., Pearson A. Nitrofurans in the treatment of gastritis associated with Campylobacter pylori. The Gastrointestinal Physiology Working Group of Cayetano Heredia and The Johns Hopkins Universities. Gastroenterology. 1988 Nov;95(5):1178–1184. doi: 10.1016/0016-5085(88)90348-4. [DOI] [PubMed] [Google Scholar]
  13. Morris A., Nicholson G. Ingestion of Campylobacter pyloridis causes gastritis and raised fasting gastric pH. Am J Gastroenterol. 1987 Mar;82(3):192–199. [PubMed] [Google Scholar]
  14. Rauws E. A., Langenberg W., Houthoff H. J., Zanen H. C., Tytgat G. N. Campylobacter pyloridis-associated chronic active antral gastritis. A prospective study of its prevalence and the effects of antibacterial and antiulcer treatment. Gastroenterology. 1988 Jan;94(1):33–40. [PubMed] [Google Scholar]
  15. Rauws E. A., Tytgat G. N. Cure of duodenal ulcer associated with eradication of Helicobacter pylori. Lancet. 1990 May 26;335(8700):1233–1235. doi: 10.1016/0140-6736(90)91301-p. [DOI] [PubMed] [Google Scholar]
  16. Unge P., Gnarpe H. Pharmacokinetic, bacteriological and clinical aspects on the use of doxycycline in patients with active duodenal ulcer associated with Campylobacter pylori. Scand J Infect Dis Suppl. 1988;53:70–73. [PubMed] [Google Scholar]
  17. Valle J., Seppälä K., Sipponen P., Kosunen T. Disappearance of gastritis after eradication of Helicobacter pylori. A morphometric study. Scand J Gastroenterol. 1991 Oct;26(10):1057–1065. doi: 10.3109/00365529109003956. [DOI] [PubMed] [Google Scholar]
  18. Wyatt J. I., Rathbone B. J., Dixon M. F., Heatley R. V. Campylobacter pyloridis and acid induced gastric metaplasia in the pathogenesis of duodenitis. J Clin Pathol. 1987 Aug;40(8):841–848. doi: 10.1136/jcp.40.8.841. [DOI] [PMC free article] [PubMed] [Google Scholar]

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