Antibiotic resistance and gyrA mutation affect the efficacy of 10-day sitafloxacin-metronidazole-esomeprazole therapy for Helicobacter pylori in penicillin allergic patients

Hideki Mori, Hidekazu Suzuki, Juntaro Matsuzaki, Tatsuhiro Masaoka, Takanori Kanai

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background and aim: Helicobacter pylori (H. pylori) eradication regimen has not been standardized for patients with penicillin allergy. We investigated the association between the efficacy of a 10-day sitafloxacin, metronidazole, and esomeprazole triple regimen and antibiotic resistance, in patients with penicillin allergy. Methods: Penicillin-allergic patients infected with H. pylori were enrolled between March 2014 and November 2015. The minimum inhibitory concentrations (MICs) of sitafloxacin and metronidazole, and the gyrA mutation status of the H. pylori strains were determined before treatment. The cut-off points for antimicrobial resistance were defined as 8.0 µg/ml for metronidazole and 0.12 µg/ml for sitafloxacin. The patients received the triple therapy (20 mg esomeprazole, bid; 250 mg metronidazole, bid; and 100 mg sitafloxacin, bid) for 10 days. Successful eradication was evaluated using the [13C] urea breath test or the H. pylori stool antigen test. Results: Fifty-seven patients were analyzed, and the overall eradication rate was 89.5%. The eradication rate in cases of double antibiotic resistance to metronidazole and sitafloxacin was 40.0%, whereas for other combinations of resistance, this was above 90.0%. Finally, the eradication rate of gyrA mutation-negative strains was 96.2%, whereas for gyrA mutation-positive strains, it was 83.9%. Adverse events were reported in 31.6% of cases, all of which were mild and tolerable. Conclusion: Ten days of sitafloxacin and metronidazole triple therapy was safe and highly effective in eradicating H. pylori in penicillin-allergic patients. Double resistance to metronidazole and sitafloxacin was an important predicting factor for eradication failure. However, 10 days of the sitafloxacin and metronidazole triple therapy was highly effective if the strain was susceptible to either sitafloxacin or metronidazole.

Original languageEnglish
Pages (from-to)796-804
Number of pages9
JournalUnited European Gastroenterology Journal
Volume5
Issue number6
DOIs
Publication statusPublished - 2017 Oct 1

Fingerprint

Esomeprazole
Metronidazole
Microbial Drug Resistance
Helicobacter pylori
Penicillins
Mutation
Therapeutics
Hypersensitivity
sitafloxacin
Breath Tests
Microbial Sensitivity Tests
Mutation Rate
Urea

Keywords

  • gyrA
  • metronidazole
  • penicillin allergy
  • Sitafloxacin

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

@article{efc665799d654c8bb9cd44c80060d53b,
title = "Antibiotic resistance and gyrA mutation affect the efficacy of 10-day sitafloxacin-metronidazole-esomeprazole therapy for Helicobacter pylori in penicillin allergic patients",
abstract = "Background and aim: Helicobacter pylori (H. pylori) eradication regimen has not been standardized for patients with penicillin allergy. We investigated the association between the efficacy of a 10-day sitafloxacin, metronidazole, and esomeprazole triple regimen and antibiotic resistance, in patients with penicillin allergy. Methods: Penicillin-allergic patients infected with H. pylori were enrolled between March 2014 and November 2015. The minimum inhibitory concentrations (MICs) of sitafloxacin and metronidazole, and the gyrA mutation status of the H. pylori strains were determined before treatment. The cut-off points for antimicrobial resistance were defined as 8.0 µg/ml for metronidazole and 0.12 µg/ml for sitafloxacin. The patients received the triple therapy (20 mg esomeprazole, bid; 250 mg metronidazole, bid; and 100 mg sitafloxacin, bid) for 10 days. Successful eradication was evaluated using the [13C] urea breath test or the H. pylori stool antigen test. Results: Fifty-seven patients were analyzed, and the overall eradication rate was 89.5{\%}. The eradication rate in cases of double antibiotic resistance to metronidazole and sitafloxacin was 40.0{\%}, whereas for other combinations of resistance, this was above 90.0{\%}. Finally, the eradication rate of gyrA mutation-negative strains was 96.2{\%}, whereas for gyrA mutation-positive strains, it was 83.9{\%}. Adverse events were reported in 31.6{\%} of cases, all of which were mild and tolerable. Conclusion: Ten days of sitafloxacin and metronidazole triple therapy was safe and highly effective in eradicating H. pylori in penicillin-allergic patients. Double resistance to metronidazole and sitafloxacin was an important predicting factor for eradication failure. However, 10 days of the sitafloxacin and metronidazole triple therapy was highly effective if the strain was susceptible to either sitafloxacin or metronidazole.",
keywords = "gyrA, metronidazole, penicillin allergy, Sitafloxacin",
author = "Hideki Mori and Hidekazu Suzuki and Juntaro Matsuzaki and Tatsuhiro Masaoka and Takanori Kanai",
year = "2017",
month = "10",
day = "1",
doi = "10.1177/2050640616688995",
language = "English",
volume = "5",
pages = "796--804",
journal = "United European Gastroenterology Journal",
issn = "2050-6406",
publisher = "SAGE Publications Inc.",
number = "6",

}

TY - JOUR

T1 - Antibiotic resistance and gyrA mutation affect the efficacy of 10-day sitafloxacin-metronidazole-esomeprazole therapy for Helicobacter pylori in penicillin allergic patients

AU - Mori, Hideki

AU - Suzuki, Hidekazu

AU - Matsuzaki, Juntaro

AU - Masaoka, Tatsuhiro

AU - Kanai, Takanori

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background and aim: Helicobacter pylori (H. pylori) eradication regimen has not been standardized for patients with penicillin allergy. We investigated the association between the efficacy of a 10-day sitafloxacin, metronidazole, and esomeprazole triple regimen and antibiotic resistance, in patients with penicillin allergy. Methods: Penicillin-allergic patients infected with H. pylori were enrolled between March 2014 and November 2015. The minimum inhibitory concentrations (MICs) of sitafloxacin and metronidazole, and the gyrA mutation status of the H. pylori strains were determined before treatment. The cut-off points for antimicrobial resistance were defined as 8.0 µg/ml for metronidazole and 0.12 µg/ml for sitafloxacin. The patients received the triple therapy (20 mg esomeprazole, bid; 250 mg metronidazole, bid; and 100 mg sitafloxacin, bid) for 10 days. Successful eradication was evaluated using the [13C] urea breath test or the H. pylori stool antigen test. Results: Fifty-seven patients were analyzed, and the overall eradication rate was 89.5%. The eradication rate in cases of double antibiotic resistance to metronidazole and sitafloxacin was 40.0%, whereas for other combinations of resistance, this was above 90.0%. Finally, the eradication rate of gyrA mutation-negative strains was 96.2%, whereas for gyrA mutation-positive strains, it was 83.9%. Adverse events were reported in 31.6% of cases, all of which were mild and tolerable. Conclusion: Ten days of sitafloxacin and metronidazole triple therapy was safe and highly effective in eradicating H. pylori in penicillin-allergic patients. Double resistance to metronidazole and sitafloxacin was an important predicting factor for eradication failure. However, 10 days of the sitafloxacin and metronidazole triple therapy was highly effective if the strain was susceptible to either sitafloxacin or metronidazole.

AB - Background and aim: Helicobacter pylori (H. pylori) eradication regimen has not been standardized for patients with penicillin allergy. We investigated the association between the efficacy of a 10-day sitafloxacin, metronidazole, and esomeprazole triple regimen and antibiotic resistance, in patients with penicillin allergy. Methods: Penicillin-allergic patients infected with H. pylori were enrolled between March 2014 and November 2015. The minimum inhibitory concentrations (MICs) of sitafloxacin and metronidazole, and the gyrA mutation status of the H. pylori strains were determined before treatment. The cut-off points for antimicrobial resistance were defined as 8.0 µg/ml for metronidazole and 0.12 µg/ml for sitafloxacin. The patients received the triple therapy (20 mg esomeprazole, bid; 250 mg metronidazole, bid; and 100 mg sitafloxacin, bid) for 10 days. Successful eradication was evaluated using the [13C] urea breath test or the H. pylori stool antigen test. Results: Fifty-seven patients were analyzed, and the overall eradication rate was 89.5%. The eradication rate in cases of double antibiotic resistance to metronidazole and sitafloxacin was 40.0%, whereas for other combinations of resistance, this was above 90.0%. Finally, the eradication rate of gyrA mutation-negative strains was 96.2%, whereas for gyrA mutation-positive strains, it was 83.9%. Adverse events were reported in 31.6% of cases, all of which were mild and tolerable. Conclusion: Ten days of sitafloxacin and metronidazole triple therapy was safe and highly effective in eradicating H. pylori in penicillin-allergic patients. Double resistance to metronidazole and sitafloxacin was an important predicting factor for eradication failure. However, 10 days of the sitafloxacin and metronidazole triple therapy was highly effective if the strain was susceptible to either sitafloxacin or metronidazole.

KW - gyrA

KW - metronidazole

KW - penicillin allergy

KW - Sitafloxacin

UR - http://www.scopus.com/inward/record.url?scp=85030257160&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85030257160&partnerID=8YFLogxK

U2 - 10.1177/2050640616688995

DO - 10.1177/2050640616688995

M3 - Article

AN - SCOPUS:85030257160

VL - 5

SP - 796

EP - 804

JO - United European Gastroenterology Journal

JF - United European Gastroenterology Journal

SN - 2050-6406

IS - 6

ER -