May 02, 2014
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H. pylori antibiotic resistance rates in Latin America merit attention

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High rates of bacterial resistance in Latin America require increased public awareness, improved antibiotic regulations and closer monitoring to help combat Helicobacter pylori and eradicate diseases such as gastric cancer, a recent review recommended.

Researchers searched PubMed and other local databases and considered 59 independent studies conducted between 1988 and 2011 on H. pylori antimicrobial resistance to seven antibiotics. The bulk (85%) considered primary resistance.

  • Metronidazole had the highest rate of resistance, reported at an average of 56% (95% CI, 49-63%), with 34 studies considering primary resistance and six others weighing secondary or unspecified resistance. Metronidazole resistance was considered less serious, however, because it can be overcome by adding bismuth to the treatment regimen or extending treatment duration.
  • Fluoroquinolones — levofloxacin or ciprofloxacin — had an average summary prevalence of resistance of 15% (95% CI, 7-25%) in analyzing seven studies.
  • Clarithromycin, which researchers said often is used in combination with other antibiotics, had the third-highest rate of resistance, with a summary prevalence of 12% (95% CI, 9-16%). Forty-two studies, including 35 assessing primary resistance, were included. When used in combination, clarithromycin and metronidazole had a summary prevalence of 7% (95% CI, 4-10) across 13 studies.
  • Tetracycline was reviewed in 24 studies, 20 for primary resistance, and showed a summary resistance prevalence of 7% (95% CI, 2-14%).
  • Amoxicillin had the second-lowest rate of resistance, with a summary prevalence of 4% (95% CI, 2-8%) in 34 studies, and researchers said that could make it an appropriate candidate for use in eradication regimens.
  • Furazolidone displayed the lowest rate of resistance (3%; 95% CI, 0-9%) but was only examined in six Brazilian studies.

“These findings stress the need for appropriate surveillance programs, improved antimicrobial regulations and increased public awareness,” the researchers wrote. “In particular, empirical use of clarithromycin as the core antibiotic in H. pylori eradication regimens may already be an obsolete strategy for some countries.”

Disclosure: The researchers report no relevant financial disclosures.