The relationship among previous antimicrobial use, antimicrobial resistance, and treatment outcomes for Helicobacter pylori infections

Article Abstract:

Background: The relationship between previous antimicrobial treatments and infection with drug-resistant Helicobacter pylori is unknown. Objectives: To determine whether pervious 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.

Patient outcomes, Causes of, Drug therapy, Drug resistance in microorganisms, Microbial drug resistance, Helicobacter infections, Author Abstract

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Duration of immunogenicity and efficacy of hepatitis B vaccine in a Yupik Eskimo population

Article Abstract:

A program to immunize Yupik Eskimos against hepatitis B (HBV, a viral disease, transmitted via body fluids, which causes impaired liver function) was initiated because the incidence of HBV had been 50 cases per 1000 Eskimos living in western Alaska. Researchers studied the impact of the HBV immunization program during a five year period (1981 through 1986) in the first long- term follow-up study of persons given HBV vaccine that included both adults and children of both sexes living in an endemic area. Despite the previously documented high rate of infection, evidence of HBV was found in only three persons who had been immunized against HBV during the follow-up period. Researchers concluded that the vaccination for HBV infection resulted in long-term protection against the disease, and they expect protection from HBV to last for a greater duration than the five year period. The success of this study led to a statewide program to immunize all susceptible Alaskan Natives, and has resulted in a dramatic decline in the annual incidence of acute HBV, from a prevaccination peak of 217 cases per 100,00 persons in 1981 to 14 cases per 100,000 in 1985.

Health aspects, Evaluation, Alaska, Inuit, Hepatitis B vaccine, Hepatitis B vaccines

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