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ARTICLE

The Relationship among Previous Antimicrobial Use, Antimicrobial Resistance, and Treatment Outcomes for Helicobacter pylori Infections

Brian J. McMahon, MD; Thomas W. Hennessy, MD, MPH; J. Michael Bensler, MD; Dana L. Bruden, MS; Alan J. Parkinson, PhD; Julie M. Morris, BS; Alisa L. Reasonover, BS; Debby A. Hurlburt, BSN; Michael G. Bruce, MD, MPH; Frank Sacco, MD; and Jay C. Butler, MD

16 September 2003 | Volume 139 Issue 6 | Pages 463-469

Background: The relationship between previous antimicrobial treatments and infection with drug-resistant Helicobacter pylori is unknown.

Objectives: To determine whether previous use of antimicrobial agents predicts subsequent antibiotic resistance of H. pylori and whether resistance affects treatment outcome.

Design: Retrospective cohort analysis of adults recruited sequentially from a clinical practice.

Setting: A referral hospital in Anchorage, Alaska.

Patients: 125 adults infected with H. pylori.

Measurements: Medical records were reviewed for antimicrobial agents prescribed in the 10 years before diagnosis with H. pylori infection. Antimicrobial susceptibility of H. pylori isolates obtained from endoscopic gastric biopsy was determined by using agar dilution. Cure was determined by using the urea breath test 2 months after antimicrobial treatment.

Results: Among the 125 patients, 37 (30%) were found to have H. pylori isolates resistant to clarithromycin and 83 (66%) were found to have H. pylori isolates resistant to metronidazole. Resistance to clarithromycin was associated with previous use of any macrolide antibiotic (P < 0.001), and resistance to metronidazole was associated with previous use of metronidazole (P < 0.001). The odds of isolates being resistant to clarithromycin increased in relation to the number of courses of macrolides received (P < 0.001). Among 53 persons treated with clarithromycin-based regimens, treatment failed in 77% of those carrying clarithromycin-resistant H. pylori (10 of 13) and 13% of those with clarithromycin-susceptible strains (5 of 40) (relative risk, 6.2 [95% CI, 1.9 to 37.1]; P < 0.001).

Conclusions: Previous use of macrolides and metronidazole is associated with H. pylori resistant to these antimicrobial agents. Clarithromycin resistance is associated with a greater risk for failure with clarithromycin-based treatments.

Editors' Notes Context Adverse effects of previous antibiotic use in patients with Helicobacter pylori infections are unclear. Contribution This retrospective study examined relationships between resistant H. pylori infections and past antibiotic use in 125 Alaskan Native adults. Clarithromycin-resistant H. pylori isolates were common (prevalence, 30%) and were associated in a dose-response manner with previous use of macrolide antibiotics. Of patients with these resistant isolates, 77% had treatment failure with clarithromycin-based regimens. Implications Previous use of macrolide antibiotics is associated with increased risk for infection with clarithromycin-resistant H. pylori and increased risk for treatment failure with that antibiotic. –The Editors

 

Author and Article Information

From Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, and Alaska Native Medical Center, Anchorage, Alaska.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Brian J. McMahon, MD, c/o Arctic Investigations Program, Centers for Disease Control and Prevention, 4055 Tudor Centre Drive, Anchorage, AK 99508; e-mail, bdm9{at}cdc.gov.

Current Author Addresses: Drs. McMahon, Hennessy, Parkinson, Bruce, and Butler, Ms. Bruden, Ms. Morris, Ms. Reasonover, and Ms. Hurlburt: Arctic Investigations Program, Centers for Disease Control and Prevention, 4055 Tudor Centre Drive, Anchorage, AK 99508.

Dr. Bensler: Department of Medicine, University of Washington School of Medicine, Room RR-511, RG-20, Seattle, WA 98195.

Dr. Sacco: Department of Surgery, Alaska Native Medical Center, 4315 Diplomacy Drive, Anchorage, AK 99508.

Author Contributions: Conception and design: B.J. McMahon, T.W. Hennessy, D.A. Hurlburt.

Analysis and interpretation of the data: B.J. McMahon, T.W. Hennessy, J.M. Bensler, D.L. Bruden, A. Reasonover, J.C. Butler.

Drafting of the article: B.J. McMahon, T.W. Hennessy, J.M. Morris.

Critical revision of the article for important intellectual content: B.J. McMahon, T.W. Hennessy, J.M. Bensler, D.L. Bruden, A.J. Parkinson, J.M. Morris, M.G. Bruce, F. Sacco, J.C. Butler.

Final approval of the article: B.J. McMahon, T.W. Hennessy, J.M. Bensler, D.L. Bruden, A.J. Parkinson, J.M. Morris, A. Reasonover, D.A. Hurlburt, M.G. Bruce, F. Sacco, J.C. Butler.

Provision of study materials or patients: B.J. McMahon, A.J. Parkinson, J.M. Morris, D.A. Hurlburt.

Statistical expertise: D.L. Bruden.

Administrative, technical, or logistic support: J.C. Butler.

Collection and assembly of data: J.M. Bensler.

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