Korean J Helicobacter Up Gastrointest Res.  2014 Dec;14(4):249-254. 10.7704/kjhugr.2014.14.4.249.

The Effect of Concomittent Therarpy and Quadruple Therapy for Patients Who Had 23S Ribosomal Ribonucleic Acid Mutated Helicobacter pylori in Daegu and Kyoungpook Area

• Jung MK
• Lee JK
• Heo J
• Kang EJ
• Lee YR

• KMID: 2305127
• DOI: http://doi.org/10.7704/kjhugr.2014.14.4.249

Abstract

BACKGROUND/AIMS
Proton pump inhibitor (PPI) and two types of antimicrobial agents, amoxicillin, and clarithromycin have been widely used for the eradication of Helicobacter pylori. However, antibiotic resistant strains has rapidly increased and has emerged as an important factor for eraducation failure.
MATERIALS AND METHODS
Patients diagnosed with chronic gastritis, peptic ulcer disease or gastric epithelial neoplasm was examined by H. pylori PCR for mutation at 23S rRNA. Positive H. pylori PCR without 23S rRNA mutation was eradicated by standard triple therapy. Patients with 23S rRNA mutation was eradicated by standard triple therapy or concomittent therapy with amoxicillin, PPI, clarithromycin and metronidazol or quadruple therapy with bismuth, PPI, tetracycline and metronidazol. We evaluated the predictors of eradication failure with regards to 23S rRNA mutation and initial eradication regimen.
RESULTS
Nine hundred sixty-one patients were studied. H. pylori PCR was positive in 35.0% of the patients and 23S rRNA mutatation was found in 22.2% of the patients. The eradication rate of H. pylori for the A2143G point mutated group with standard triple therapy was 28.5% and significantly lower than 93.1% of the wild type group and 100% of the concomitant therapy group, 66.6% of one week quadruple group and 100% of two week quadruple group (P<0.005).
CONCLUSIONS
When 23S rRNA point mutation was positive, the standard triple therapy was not effective and the eradication rates was only 22.2%. Alternative regimens should be considered when 23S rRNA point mutation is detected, especially when A2143G point mutation is detected because A2143G point mutation is highly related to eradication failure.

Keyword

Helicobacter pylori; 23S rRNA; Clarithromycin; Resistance

MeSH Terms

Amoxicillin
Anti-Infective Agents
Bismuth
Clarithromycin
Daegu
Gastritis
Helicobacter pylori*
Humans
Neoplasms, Glandular and Epithelial
Peptic Ulcer
Point Mutation
Polymerase Chain Reaction
Proton Pumps
RNA*
Tetracycline
Amoxicillin
Anti-Infective Agents
Bismuth
Clarithromycin
Proton Pumps
RNA
Tetracycline