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Primary clarithromycin resistance in Helicobacter pylori: the Multicentric Italian Clarithromycin Resistance
Vincenzo De Francesco1, Floriana Giorgio, Enzo Ierardi
1Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Ospedali Riuniti,Viale L. Pinto 71100, Foggia, Italy. vdefrancesco@ospedaliriunitifoggia.it
Background:
Primary clarithromycin resistance markedly reduces Helicobacter pylori eradication rate following standard therapies. Prevalence of primary clarithromycin resistance in H. pylori is increasing, and three point mutations are mainly involved. AIM. To assess both the prevalence of primary clarithromycin resistance in Italy, and the distribution of the involved point mutations.
Methods:
Primary clarithromycin resistance was assessed by TaqMan real-time polymerase chain reaction on antral biopsies of 253 consecutive, H. pylori infected patients enrolled in 13 Italian centres between January and September 2010.
Results:
Primary clarithromycin resistance was detected in 25 (9.9%) patients, with prevalence values widely ranging from 0 to 25%. Clarithromycin resistance rate was higher in female as compared to male patients (13.4% vs. 5.3%, p=0.03), and it tended to be higher in non-ulcer dyspepsia than in peptic ulcer patients (10.6% vs. 6.9%, p=0.5), female patients with non-ulcer dyspepsia showing the highest value (15.4%). The A2143G point mutation was detected in 13 (52.0%) patients, the A2142G in 9 (34.6%), whilst a double point mutation (A2143G plus A2142G) in 3 (11.6%) cases.
Conclusions:
Primary clarithromycin resistance is highly variable in different Italian geographic areas. High resistance rates were observed in female and in dyspeptic patients. Among the three point mutations of clarithromycin resistance, the A2143G remains the most frequently observed.
Insights
Primary clarithromycin resistance in Helicobacter pylori is increasing, with significant variability across Italy. The A2143G mutation is the most common cause of resistance, particularly in female and dyspeptic patients.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Gastroenterology
Background:
- Primary clarithromycin resistance significantly reduces Helicobacter pylori eradication rates with standard therapies.
- The prevalence of primary clarithromycin resistance in H. pylori is rising globally.
- Three specific point mutations are primarily responsible for clarithromycin resistance.
Purpose of the Study:
- To determine the prevalence of primary clarithromycin resistance in H. pylori within Italy.
- To analyze the distribution of point mutations conferring clarithromycin resistance.
Main Methods:
- TaqMan real-time polymerase chain reaction (PCR) was employed to assess resistance.
- Antral biopsies from 253 H. pylori-infected patients were analyzed.
- Data were collected from 13 Italian centers between January and September 2010.
Main Results:
- Overall primary clarithromycin resistance was detected in 9.9% of patients, with significant geographic variation (0-25%).
- Resistance rates were higher in female (13.4%) versus male (5.3%) patients and in non-ulcer dyspepsia (10.6%) versus peptic ulcer patients (6.9%).
- The A2143G mutation was most frequent (52.0%), followed by A2142G (34.6%), and a double mutation (11.6%).
Conclusions:
- Primary clarithromycin resistance in H. pylori exhibits high variability across Italian regions.
- Elevated resistance rates were noted in female and dyspeptic patient groups.
- The A2143G point mutation remains the predominant mechanism for clarithromycin resistance in H. pylori.