Awareness of regional antibiotic resistance rates allows a more targeted and evidence-based treatment regime to be administered to individual patients. A recent paper reported for the first time on the trends occurring over the past 25 years along with regional differences in antibiotic resistance rates for Helicobacter pylori (H. pylori) in conjunction with first-line eradication regimens focussing on the Asia-Pacific region. H. pylori infection has been reported to be responsible for up to 90% of gastric cancer, therefore eradication is likely to result in significant health improvements population-wide. A comprehensive review and meta-analysis of observational and randomised controlled trials was carried out incorporating data from 176 articles from 24 countries published during January 1990 through September 2016. Subgroup analysis was performed looking at four periods: before 2000, 2000–05, 2006–10, and 2011–15.

The overall mean prevalences of primary H. pylori resistance were 3% for amoxicillin; 4% for tetracycline; 17% for clarithromycin, ranging from 0% in Bhutan and Myanmar to 34% in Vietnam and 37% in Pakistan; 18% for levofloxacin, ranging from 2–3% (Bhutan and Malaysia) to 66% in Bangladesh; 44% for metronidazole, ranging from 10% in Japan to 84% in Bangladesh and 88% in Nepal. (The authors noted that different antibiotics of the same class were combined in analyses of antibiotic resistance or eradication rates, e.g. ciprofloxacin, levofloxacin and moxifloxacin). Over the period, resistance increased significantly to both clarithromycin and levofloxacin, but remained stable for the other antibiotics. Subgroup analysis showed that overall clarithromycin resistance increased from 7% before 2000 to 21% in 2011–15; metronidazole resistance increased from 36% before 2000 to 45% in 2011–15; levofloxacin resistance increased from 2% before 2000 to 27% during in 2011–15.

The second part of the review focused on the efficacy of first-line H. pylori eradication therapies and incorporated data from 170 articles from 16 countries. The authors noted that an unsatisfactory outcome defined as less than 80% efficacy was found when using clarithromycin-containing regimens in countries where the clarithromycin resistance rates were higher than 20%.

It was important to note that the prevalence of primary antibiotic resistance differed markedly throughout the Asia-Pacific region, leading researchers to emphasise that treatment regimens need to be based upon relative regional resistance patterns.

According to data for 2006–15, clarithromycin resistance was higher than 15% in 13 countries: Bangladesh, China, India, Iran, Japan, Nepal, New Zealand, Pakistan, Saudi Arabia, Singapore, South Korea, Turkey, and Vietnam. Metronidazole resistance was higher than 40% in most included countries, except Japan, Myanmar, South Korea, Taiwan, and Turkey. Levofloxacin resistance in the most recent collection period was higher than 20% in nine countries: Bangladesh, China, Indonesia, Japan, Nepal, Russia, South Korea, Turkey, and Vietnam. Mean overall resistance was high (i.e., >10%) to both amoxicillin and tetracycline in India and Pakistan.

Although the study has limitations, the authors noted that the rise in clarithromycin and levofloxacin resistance in the past 25 years throughout the Asia-Pacific region is concerning, and highlights the need for effective strategies to control antibiotic resistance.

PMID: 28781119

J Infect Chemother. 2017 Aug;23(8):556-562. doi: 10.1016/j.jiac.2017.05.005. Epub 2017 Jun 3.

Source: https://www.ncbi.nlm.nih.gov/pubmed/28781119?dopt=Abstract