Changing profile of Helicobacter pylori primary antibiotic resistance in Singapore over two decades. Issue 5 (15th August 2022)

• Record Type: Journal Article
• Authors: Pei, Yiying; Ang, Daphne; Kwek, Andrew Boon Eu; Ang, Tiing Leong
• Is Part Of: Journal of digestive diseases. Volume 23:Issue 5/6(2022)
• Page Start: 295
• Page End: 301
• Publication Date: 2022-08-15
• Subjects: antibiotic resistance -- Helicobacter pylori -- triple therapy; Digestive organs -- Diseases -- Periodicals; Gastroenterology -- Periodicals; 616.3
• DOI: 10.1111/1751-2980.13115
• Languages: English
• ISSNs: 1751-2972

Abstract

Abstract : Objectives: Antibiotic resistance is a key reason for Helicobacter pylori ( H. pylori ) treatment failure and updated local data are important to guide the choice of empiric first‐line therapy. Clarithromycin‐based triple therapy (TT) is currently the first‐line treatment in Singapore. Our primary aim was to determine the change in pattern of primary antibiotic resistance of H. pylori in Singapore as well as TT success rate. Methods: A registry of H. pylori isolates was tested for primary antibiotic resistance and were analyzed from year 2001 to 2020. Treatment outcome data based on 13 C‐urea breath test ( 13 C‐UBT) results of empiric first‐line 2‐week TT from 2019 to 2020 were also analyzed retrospectively. Results: A total of 387 H. pylori isolates were included. Rates of resistance to clarithromycin as well as tetracycline showed a downtrend in the last 5 years (clarithromycin: 2001–2002: 8.57%; 2007–2008: 14.14%; 2013–2014: 18.09%; 2019–2020: 13.71%; tetracycline: 2001–2002: 5.71%; 2007–2008: 7.07%; 2013–2014: 7.45%; 2019–2020: 0%). The resistance rate for amoxicillin remained low (2001–2002: 2.86%; 2007–2008: 5.05%; 2013–2014: 4.26%; 2019–2020: 7.26%). There was a steady increase in the rate of levofloxacin resistance (2001–2002: 5.71%; 2007–2008: 11.11%; 2013–2014: 15.96%; 2019–2020: 16.94%). From 2019 to 2020, the rate of successful TT was 91.67% (891/972). Conclusion: The latest rate of clarithromycin resistance in 2019 to 2020 remained below the threshold of 15% and eradication rates remain high; thus, TT remains appropriate as an empiric first‐line treatment in Singapore. Abstract : We studied the antibiotic resistance trend of Helicobacter pylori ( H. pylori ) over the last 20 years and found that the latest rate of clarithromycin resistance in 2019 to 2020 remained below the threshold of 15%. At the same time, eradication rates with 2‐week triple therapy remained high; hence, the data support the continued use of triple therapy as an empiric first‐line treatment for H. pylori in Singapore.