 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
The researchers reviewed outpatient, hospital, and pharmacy records to see which patients had taken antibiotics in the past. The researchers noted any antibiotic use in the 8 to 10 years before endoscopy. They then compared previous use of antibiotics in patients with and without resistant infections.
SUMMARIES FOR PATIENTS
Past Antibiotic Use Affects Resistance and Outcomes of Helicobacter pylori Infection
16 September 2003 | Volume 139 Issue 6 | Page I-10
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full report titled "The Relationship among Previous Antimicrobial Use, Antimicrobial Resistance, and Treatment Outcomes for Helicobacter pylori Infections." It is in the 16 September 2003 issue of Annals of Internal Medicine (volume 139, pages 463-469). The authors are B.J. McMahon, T.W. Hennessy, J.M. Bensler, D.L. Bruden, A.J. Parkinson, J.M. Morris, A.L. Reasonover, D.A. Hurlburt, M.G. Bruce, F. Sacco, and J.C. Butler.
What is the problem and what is known about it so far?
Helicobacter pylori is a common type of bacteria that usually infects people during their childhoods. In most cases, the infection does not cause problems. However, some people with H. pylori infection get inflammation or ulcers in the stomach or upper intestine. Doctors treat inflammation and ulcers caused by H. pylori with several antibiotics (for example, amoxicillin, clarithromycin, or metronidazole) for several days. Antibiotics get rid of H. pylori in most patients, but 10% to 20% of patients may still have infection despite treatment. Several factors may predispose patients to "antibiotic-resistant" infections. One possible factor is previous use of antibiotics that left behind resistant bacteria.
Why did the researchers do this particular study?
To see if past use of antibiotics affects resistance and treatment outcomes of H. pylori infections.
Who was studied?
125 Alaska Native adults infected with H. pylori. All had endoscopy for symptoms such as heartburn, nausea, or vomiting.
How was the study done?
At endoscopy, doctors removed small amounts of infected tissue from each patient's stomach. They sent the tissue for culture to see if it grew H. pylori and, if it did, tested the H. pylori to see if it was sensitive or resistant to several antibiotics. Then, the doctors treated the infected patients for 2 weeks with 2 to 3 different antibiotics. Patients were given tests (urea breath tests) 2 months after treatment to see if they still had H. pylori infection.
What did the researchers find?
One third of the H. pylori infections were resistant to clarithromycin (a macrolide antibiotic). Two thirds were resistant to metronidazole. People who had used the same or a similar antibiotic in the past more commonly had infections that were resistant to that antibiotic. People who had taken many previous courses of macrolide antibiotics had greater risk for H. pylori infections that were resistant to clarithromycin than did people who had used those antibiotics less often. Seventy-seven percent of the patients with clarithromycin-resistant H. pylori infection had persistent infections after treatment with drug regimens that included clarithromycin.
What were the limitations of the study?
Alaska Natives have a very high prevalence of H. pylori infections. Findings in this group might differ from those in other patient groups in whom H. pylori infection is less common. Also, past antibiotic use may have been underestimated. The study was based on review of records at the Alaska Native Medical Center, and some persons may have received antibiotics from other places. Only 96 of 125 patients had breath tests to see if infection remained after treatment.
What are the implications of the study?
People who have used antibiotics in the past have increased risks for H. pylori infections that are resistant to those antibiotics. Clarithromycin-containing therapy for H. pylori infection often fails in people who are resistant to clarithromycin.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  M Romano, M R Iovene, M I Russo, A Rocco, R Salerno, D Cozzolino, A P Pilloni, M A Tufano, D Vaira, and G Nardone Failure of first-line eradication treatment significantly increases prevalence of antimicrobial-resistant Helicobacter pylori clinical isolates J. Clin. Pathol., October 1, 2008; 61(10): 1112 - 1115. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. J. Demma, R. C. Holman, J. Sobel, K. L. Yorita, T. W. Hennessy, E. L. Paisano, and J. E. Cheek Epidemiology of Hospitalizations Associated with Ulcers, Gastric Cancers, and Helicobacter pylori Infection among American Indian and Alaska Native Persons Am J Trop Med Hyg, May 1, 2008; 78(5): 811 - 818. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Kobayashi, K. Murakami, M. Kato, S. Kato, T. Azuma, S. Takahashi, N. Uemura, T. Katsuyama, Y. Fukuda, K. Haruma, et al. Changing Antimicrobial Susceptibility Epidemiology of Helicobacter pylori Strains in Japan between 2002 and 2005 J. Clin. Microbiol., December 1, 2007; 45(12): 4006 - 4010. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P Malfertheiner, F Megraud, C O'Morain, F Bazzoli, E El-Omar, D Graham, R Hunt, T Rokkas, N Vakil, E J Kuipers, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report Gut, June 1, 2007; 56(6): 772 - 781. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S Koletzko, F Richy, P Bontems, J Crone, N Kalach, M L Monteiro, F Gottrand, D Celinska-Cedro, E Roma-Giannikou, G Orderda, et al. Prospective multicentre study on antibiotic resistance of Helicobacter pylori strains obtained from children living in Europe Gut, December 1, 2006; 55(12): 1711 - 1716. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Francois and M. J. Blaser Improving Helicobacter pylori Eradication Regimens Ann Intern Med, January 17, 2006; 144(2): 140 - 141. [Full Text] [PDF]
|
|
|
|
|
|
J. M. Morris, A. L. Reasonover, M. G. Bruce, D. L. Bruden, B. J. McMahon, F. D. Sacco, D. E. Berg, and A. J. Parkinson Evaluation of seaFAST, a Rapid Fluorescent In Situ Hybridization Test, for Detection of Helicobacter pylori and Resistance to Clarithromycin in Paraffin-Embedded Biopsy Sections J. Clin. Microbiol., July 1, 2005; 43(7): 3494 - 3496. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. S. Howell-Jones, M. J. Wilson, K. E. Hill, A. J. Howard, P. E. Price, and D. W. Thomas A review of the microbiology, antibiotic usage and resistance in chronic skin wounds J. Antimicrob. Chemother., February 1, 2005; 55(2): 143 - 149. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Nahar, A. K. Mukhopadhyay, R. Khan, M. M. Ahmad, S. Datta, S. Chattopadhyay, S. C. Dhar, S. A. Sarker, L. Engstrand, D. E. Berg, et al. Antimicrobial Susceptibility of Helicobacter pylori Strains Isolated in Bangladesh J. Clin. Microbiol., October 1, 2004; 42(10): 4856 - 4858. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. J. Greenberger and P. Sharma Update in Gastroenterology and Hepatology Ann Intern Med, September 7, 2004; 141(5): 374 - 380. [Full Text] [PDF]
|
|
|
|
|
|
F Megraud H pylori antibiotic resistance: prevalence, importance, and advances in testing Gut, September 1, 2004; 53(9): 1374 - 1384. [Full Text] [PDF]
|
|
|
|
|
|
J. Seow and F. T. Chew Risk Factors for Helicobacter pylori Resistance Ann Intern Med, June 1, 2004; 140(11): 931 - 931. [Full Text] [PDF]
|
|
|
|
 |
|
 H. pylori Treatment Resistance Journal Watch Dermatology, November 26, 2003; 2003(1126): 9 - 9. [Full Text]
|
|
|
|
 |
|
 H. pylori Treatment Resistance Journal Watch (General), October 14, 2003; 2003(1014): 4 - 4. [Full Text]
|
|
|
|
|
|
L. B. Rice Collateral Damage Ann Intern Med, September 16, 2003; 139(6): 523 - 524. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Article
