Study Assesses Effectiveness of Antibiotics in Treating H. Pylori

Investigators found that tetracycline, rifabutin, and amoxicillin have shown better results in treating treat Helicobacter pylori (H. pylori) compared to metronidazole, levofloxacin, and clarithromycin. The results of these findings are published in the American Journal of Gastroenterology.

“Metronidazole, levofloxacin, and clarithromycin resistance rates each exceed 30%; thus, choosing an empiric antibiotic regimen without knowledge of the likely pattern of antibiotic resistance is not appropriate,” the authors wrote in the report.

Understanding which antibiotics have the most effect and the least effect on various strains of H. pylori would help clinicians prescribe accordingly. In recent years, trends have shown declining rates of eradication of H. pylori among patients, due in part to the global rise of antimicrobial resistance among H. pylori strains.

For this systematic review, the authors reviewed data on 2,660 samples of H. pylori strains obtained from 19 studies spanning between 2011 and 2021 from Ovid MEDLINE, Embase, CINAHL, and Cochrane CENTRAL databases. The researchers drew estimates of the resistance of the strains to the following 6 antibiotics: clarithromycin, amoxicillin, metronidazole, tetracycline, rifabutin, and levofloxacin, or a combination of these.

Three of these antibiotics showed more than 30% resistance to H. pylori strains— metronidazole at 42.1%, levofloxacin at 37.6%, and clarithromycin at 31.5%. On the other hand, the antibiotics that showed less resistance to the various strains were amoxicillin at 2.6%, tetracycline at 0.87%, and rifabutin at 0.17%.

“Given the scarcity of available data with considerable heterogeneity among studies, continued surveillance, ideally with a more systematic approach to data collection, is an increasingly important goal in H. pylori management,” the authors concluded.

—Priyam Vora

Reference:
Ho J, Navarro M, Sawyer K, Yousef E, Moss S. Helicobacter pylori antibiotic resistance in the United States between 2011 and 2021: A systematic review and meta-analysis. Am J Gastroenterol. 2022;117(8):1221-1230. DOI: 10.14309/ajg.0000000000001828