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Success of susceptibility-guided eradication of Helicobacter pylori in a region with high secondary clarithromycin and levofloxacin resistance rates

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World Journal of Gastroenterology 2024年第2期30卷 184-195页

作者： Yan-Meng Wang Mo-Ye Chen Jing Chen Xin-He Zhang Yan Feng Yu-Xi Han Yi-Ling Li Department of Gastroenterology The First Affiliated Hospital of China Medical UniversityShenyang 110000Liaoning ProvinceChina Key Laboratory of Cancer Etiology and Prevention in Liaoning Education Department The First Hospital of China Medical UniversityShenyang 110000Liaoning ProvinceChina

BACKGROUND Resistance to clarithromycin(CLA)and levofloxacin(LFX)of Helicobacter pylori(H.pylori)is increasing in severity,and successful eradication is essential.Presently,the eradication success rate has greatly declined,leaving a large number of patients with previous treatment histories.AIM To investigate secondary resistance rates,explore risk factors for antibiotic resistance,and assess the efficacy of susceptibility-guided therapy.METHODS We recruited 154 subjects positive for Urea Breath Test who attended The First Affiliated Hospital of China Medical University between July 2022 and April 2023.Participants underwent a string test after an overnight fast.The gastric juice was obtained and transferred to vials containing storage solution.Subsequently,DNA extraction and the specific DNA amplification were performed using quantitative polymerase chain reaction(qPCR).Demographic information was also analyzed as part of the study.Based on these results,the participants were administered susceptibility-guided treatment.Efficacy was compared with that of the empiric treatment group.RESULTS A total of 132 individuals tested positive for the H.pylori ureA gene by qPCR technique.CLA resistance rate reached a high level of 82.6%(n=109),LFX resistance rate was 69.7%(n=92)and dual resistance was 62.1%(n=82).Gastric symptoms[odds ratio(OR)=2.782;95%confidence interval(95%CI):1.076-7.194;P=0.035]and rural residence(OR=5.152;95%CI:1.407-18.861;P=0.013)were independent risk factors for secondary resistance to CLA and LFX,respectively.A total of 102 and 100 individuals received susceptibility-guided therapies and empiric treatment,respectively.The antibiotic susceptibility-guided treatment and empiric treatment groups achieved successful eradication rates of 75.5%(77/102)and 59.0%(59/411)by the intention-to-treat(ITT)analysis and 90.6%(77/85)and 70.2%(59/84)by the per-protocol(PP)analysis,respectively.The eradication rates of these two treatment strategies were significantly different in both ITT(P=0.001)and PP(P=0.012)ana

关键词： Helicobacter pylori Antibiotic resistance clarithromycin Levofloxacin String-test Susceptibility-guided therapy Eradication rate

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Efficacy and safety of clarithromycin for patients with sepsis or septic shock:a systematic review and meta-analysis

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Emergency and Critical Care Medicine 2024年第2期4卷 90-96页

作者： Pengyue Zhao Renqi Yao Jiaqi Yang Wei Wen Yongming Yao Xiaohui Du Department of General Surgery First Medical Center of the Chinese PLA General HospitalBeijingChina Translational Medicine Research Center Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General HospitalBeijingChina Department of Burn Surgery the First Affiliated Hospital of Naval Medical UniversityShanghaiChina Department of General Surgery Hainan Hospital of Chinese PLA General HospitalSanyaHainanChina.

Background:clarithromycin exerts an immunomodulatory role in several human diseases.However,whether this effect improves the prognosis in patients with sepsis remains controversial,and higher levels of clinical evidence are urgently needed.To the best of our knowledge,no meta-analysis to date has reported the clinical efficacy and safety of clarithromycin in sepsis.Methods:A comprehensive literature search of PubMed,EMBASE,and the Cochrane Library was conducted up to December 31,2022.Only randomized controlled trials comparing the clinical efficacy and safety of clarithromycin with controls among patients with sepsis or septic shock were included.Data were pooled by applying a fixed-effects model and a relative risk(RR)estimate with 95%confidence intervals(CIs)using Review Manager(version 5.3;Cochrane Collaboration,Copenhagen,Denmark).Results:Three randomized controlled trials involving a total of 910 patients were included.The pooled results confirmed that clarithromycin had no beneficial effect on progression to multiple organ dysfunction syndrome(RR:1.51;95%CI:1.02-2.25;P=0.04;I^(2)=0%),28-day mortality(RR:1.09;95%CI:0.87-1.36;P=0.46;I^(2)=0%),and 90-day mortality(RR:0.86;95%CI:0.71-1.03;P=0.10;I^(2)=81%)in patients with sepsis or septic shock.Moreover,there was no difference in other serious adverse events between patients who received clarithromycin and those in the control group(RR:1.02;95%CI:0.87-1.19;P=0.83;I^(2)=18%).Conclusion:Our meta-analysis did not reveal an improvement to short-term outcomes in patients with sepsis treated with clarithromycin.However,administration of clarithromycin did not increase the risk of adverse events.

关键词： clarithromycin Meta-analysis Outcomes Sepsis Septic shock

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Telithromycin versus clarithromycin for the treatment of community-acquired respiratory tract infections： a meta-analysis of randomized controlled trials

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Chinese Medical Journal 2013年第11期126卷 2179-2185页

作者： LI Xiu-min WANG Feng-chun YANG Feng JIN Ying-hua Department of Pharmacy Military General Hospital of Beijing PLABeijing 100700 China

Background The emergence of bacterial resistance to commonly used antibiotics, such as macrolides, is complicating the management of respiratory tract infections （RTIs）. Telithromycin, a ketolide antimicrobial structurally related to macrolides, is approved for the treatment of community-acquired RTIs, and shows lower pathogen resistance rates. The purpose of this study was to compare the efficacy and safety of telithromycin with clarithromycin, a macrolide routinely used as therapy for RTIs. Methods We performed a meta-analysis of relevant randomized-controlled trials （RCTs） identified in PubMed, the Cochrane Library, Embase, CNKI and VIP databases. The primary efficacy outcome was clinical treatment success assessed at the test-of-cure time in the per-protocol population, and the primary safety outcome was drug related adverse effects. Results Seven RCTs, involving 2845 patients with RTIs, were included in the meta-analysis. Oral telithromycin and clarithromycin showed a similar clinical treatment success in modified intention to treat and per-protocol population （cure and improvement）（odds ratios （ORs）： 0.84, 95% confidence intervals （C/）： 0.64-1.11 and OR： 1.14, 95% CI： 0.71-1.85, respectively）. Similar findings were obtained for secondary efficacy outcomes： clinical treatment success at a late post- therapy visit （OR： 0.92, 95% CI： 0.57-1.48） and microbiological treatment success at the test-of-cure time （OR： 1.14; 95% CI： 0.71-1.85）. The safety outcome analysis indicated telithromycin had a similar risk of drug-related adverse effect and serious adverse effect with clarithromycin. Conclusions Our findings indicate that oral telithromycin and clarithromycin have similar treatment efficacy and adverse effect. The advantages of lower antimicrobial resistance rates, once-daily short-duration dosing and reported lower health- care costs make oral telithromycin a useful option for the empiric management of mild-to-moderate RTIs.

关键词： telithromycin clarithromycin community-acquired respiratory tract infections meta-analysis

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Resistance to clarithromycin and gastroenterologist's persistence roles in nomination for Helicobacter pylori as high priority pathogen by World Health Organization

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World Journal of Gastroenterology 2017年第35期23卷 6379-6384页

作者： Amin Talebi Bezmin Abadi Department of Bacteriology Faculty of Medical SciencesTarbiat Modares University

Due to the increasing prevalence of clarithromycin resistance, future of management of Helicobacter pylori(H. pylori) infections need to be recognized. To now, clarithromycin was the best effective, well-tolerated and safe antibiotic used in treatment of the bacterium, but, increasing trend of resistance reduced efficacy of recommended regimens. Indeed, gastroenterologists are mostly unable to start appropriate therapyaccording to the sensitivity profile-due to the certain difficulties in routine H. pylori culture procedure and being time consuming method. This announcement by World Health Organization(WHO) was an onset to reconsider current challenging dilemma about H. pylori clarithromycin resistant isolates. Therefore, investigating of various factors affecting this nomination by WHO is highly welcomed. In fact, WHO enumerated more than 16 pathogens which seriously threats human life and public health, thus better management or effective guidelines are necessary. Here for the first time, we nominated this phenomenon as ‘‘gastroenterologist's persistence'' which should be equally investigated as antibiotic resistance. The ability of gastroenterologists to win the game against H. pylori infections is highly influenced by their collaboration with diagnostic laboratories to apply susceptibility patterns before any prescription. In conclusion, closer collaboration between two important partners(gastroenterologists and microbiologists) in management of H. pylori infection may hopefully trigger an era to remedy current crisis in clarithromycin resistance, a later gastric cancer can be practically preventable.

关键词： Resistance clarithromycin Helicobacter pylori World Health Organization

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An intravenous clarithromycin lipid emulsion with a high drug loading, H-bonding and a hydrogen-bonded ion pair complex exhibiting excellent antibacterial activity

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Asian Journal of Pharmaceutical Sciences 2016年第5期11卷 618-630页

作者： Haoyu Gong Sicong Geng Qi Zheng Puxiu Wang Lifeng Luo Xiuzhi Wang Yan Zhang Yu Zhang Haibing He Xing Tang Shenyang Pharmaceutical University

The aim of this study was to develop an intravenous clarithromycin lipid emulsion(CLE)with good stability and excellent antibacterial activity. The CLE was prepared by the thinfilm dispersed homogenization method. The interaction between clarithromycin(CLA) and cholesteryl hemisuccinate(CHEMS) was confirmed by DSC, FT-IR and^1H NMR analysis. The interfacial drug loading, thermal sterilization, freeze–thaw stability, and in vitro and in vivo antibacterial activity were investigated systematically. DSC, FT-IR and^1H NMR spectra showed that CHEMS(CLA: CHEMS, M ratio 1:2) could interact with CLA through H-bonding and a hydrogen-bonded ion pair. The CHEMS was found necessary to maintain the stability of CLE.Ultracentrifugation showed that almost 88% CLA could be loaded into the interfacial layer.The optimized CLE formulation could withstand autoclaving at 121 °C for 10 min and remain stable after three freeze–thaw cycles. The in vitro susceptibility test revealed that the CLA–CHEMS ion-pair and CLE have similar activity to the parent drug against many different bacterial strains. The in vivo antibacterial activity showed that the ED50 of intravenous CLE was markedly lower than that of CLA solution administrated orally. CLE exhibited pronounced antibacterial activity and might be a candidate for a new nanocarrier for CLA with potential advantages over the current commercial formulation.

关键词： clarithromycin Cholesteryl hemisuccinate H-bonding and hydrogen-bonded ion pair complex Antibacterial activity Thin-film dispersed homogenization

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Study on the interaction between clarithromycin and bovine serum albumin in the imitated physiology solution

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Chinese Chemical Letters 2007年第6期18卷 726-729页

作者： She Ying Dong[a]&Email:dongsyy@*** Chun Xia Xue[a] Ting Lin Huang[b] [a]College of Sciences Xi’an University of Architecture and Technology Xi’an 710055 Shaanxi China [b]School of Environment and Municipal Engineering Xi’an University of Architecture and Technology Xi’an 710055 Shaanxi China

The interaction between clarithromycin (CAM) and bovine serum albumin (BSA) was investigated using linear-sweep voltammetry in pH 7.4 phosphate buffer solution where CAM caused two irreversible reduction waves P2 and P3 on mercury electrode. The study showed that the formation constant and formation ratio for the interaction between CAM and BSA were 1.51 × 10(12) and 3:1 for P2, 4.53 × 10(5) and 1:1 for P3, respectively. The ion strength enhanced the hydrophobic interaction between CAM and BSA.

关键词： clarithromycin Bovine serum albumin Interaction Linear-sweep voltammetry

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Possible convulsion and electroencephalographic abnormality in a patient taking long-term oral clarithromycin:A case report

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World Journal of Neurology 2022年第2期8卷 10-13页

作者： Wataru Shiraishi Department of Neurology Kokura Memorial HospitalKitakyushu 802-8555FukuokaJapan

BACKGROUND clarithromycin is a macrolide antibiotic commonly prescribed to patients with upper respiratory and otolaryngological infections.Neuropsychiatric adverse effects of clarithromycin include agitation,insomnia,delirium,psychosis,and seizure.CASE SUMMARY A 52-year-old man was admitted to our hospital with a convulsion.He had>10-year history of clarithromycin intake for chronic sinusitis.One week before admission,he started to take diltiazem for angina pectoris.On admission,his convulsion subsided.His electroencephalography showed frontal intermittent rhythmic delta activity.One week after he ceased clarithromycin,his electroencephalographic abnormalities disappeared.We suggested that the patient developed convulsions due to increased blood levels of clarithromycin caused by oral administration of diltiazem,which is involved in CYP3A metabolism.CONCLUSION clarithromycin has a relatively high safety profile and is a frequently prescribed drug.However,there are a few previous reports of clarithromycin-related convulsive disorders.Clinicians should be aware of the drug interaction and rare side effects of seizures.

关键词： clarithromycin Convulsion QT interval prolongation Seizures Case report

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Microcalorimetric Study on the Antibiotic Activity of clarithromycin and Erythromycin

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Wuhan University Journal of Natural Sciences 2000年第2期5卷 215-218页

作者： Shen Xue-song Liu Yi Zhou Chuan-pei Zhao Ru-ming Qu Song-sheng College of Chemistry and Environment Science Wuhan University Wuhan 430072 China Guilin Medical College Guilin 54001 China College of Chemistry and Environment Science Wuhan University Wuhan 430072 China College of Chemistry and Environment Science Wuhan University Wuhan 430072 China

By using LKB-2277 Bioactivity Monitoring System, the heat effect changes in the process of inhibitory action of clarithromycin and erythromycin onEscherichia coli at 37°C were determined. Quantitative analysis showed that relationship between antibiotic concentrationc and rate contantk ofEscherichia coli growth, and half inhibitory ratio concentration IC50: clarithromycin:k=0. 030 03–1. 1736×10?3 c, 8. 45 mg ·L?1; erythromycin:k=0.031 08–8.4657×10?4 c, 14. 45 mg·L?1. As a result of the microcalorimetry experiments, it not only indicated that antibacterial activity of clarithromycin was stronger than that of erythromycin, but also reported the changeable features of thermodynamics of the bacterial cell in biological, biochemical and metabolic process under different drug action.

关键词： clarithromycin erythromycin escherichia coli microcalorimetry

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Omeprazole,clarithromycin and amoxicillin therapy for Helicobacter pylori infection

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中华内科杂志 1998年第ZK期37卷 36-38页

作者：陈寿坡陈志强贝濂温淑豪 DepartmentofGastroenterology PekingUnionMedicalCollegeHospitalChineseAcademyofMedicalSciencesBeijing

Objective To determine the eradication rate of Helicobacter pylori (HP) infection using omeprazole 20 mg twice daily, clarithromycin 500 mg twice daily and amoxicillin 1000 mg twice daily for one or two weeks, in comparison with colloidal bismuth subcitrate 240 mg twice daily, amoxicillin 1000 mg twice daily and metronidazole 400 mg twice daily for two weeks. Methods 141 patients with Hp associated chronic gastritis or duodenal ulcer were randomly divided into 3 groups. Group Ⅰ(n＝48) was treated with triple therapy (omeprazole, clarithromycin and amoxicillin) for 1 week, Group Ⅱ (n＝47) treated with triple therapy for two weeks, Group Ⅲ (n＝46) treated with colloidal bismuth subcitrate, amoxicillin and metronidazole for 2 weeks. The Hp status was determined by rapid urease test and histology of Warthin-Starry silver stain. Results The eradication rates of Group Ⅰ, Group Ⅱ and Group Ⅲ were 89.6％, 95.7％ and 71.7％ respectively. The difference between Group Ⅰ and Group Ⅲ or between Group Ⅱ and Group Ⅲ was significant. There was no significant difference in the eradication rates between Group Ⅰ and Group Ⅱ. Side effects in Group Ⅲ was more frequent than in Group Ⅰ and Ⅱ. Although 21.1％ of the patients in Group Ⅰ and Ⅱ experienced a metallic taste, none discontinued in medication. Conclusion Our results show that triple therapy with omeprazole, clarithromycin and amoxicillin is an effective and well tolerated treatment for eradication of Hp infection and may be an alternative to the old standard triple therapy.

关键词： Omeprazole clarithromycin Amoxicillin Helicobacter pylori

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Omeprazole,clarithromycin and amoxicillin therapy for Helicobacter pylori infection

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中华内科杂志 1998年第Z1期 38页

作者：陈寿坡陈志强贝濂温淑豪 DepartmentofGastroenterology PekingUnionMedicalCollegeHospitalChineseAcademyofMedicalSciencesBeijing

关键词： Omeprazole clarithromycin Amoxicillin Helicobacter pylori

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