Clarithromycin resistance and efficacy of clarithromycin-containing triple eradication therapy for Helicobacter pylori infection in type 2 diabetes mellitus patients.
BACKGROUND
Antimicrobial resistance in Helicobacter pylori infection is an important factor leading to failure of therapy. The aim of this study was to determine the eradication rate of H pylori in type 2 diabetes mellitus and to assess the effect of clarithromycin resistance on H pylori eradication.


METHODS
Fifty-six consecutive patients with type 2 diabetes mellitus and 58 age- and sex-matched control patients were included in the study. H pylori infection was assessed by a rapid urease test and histopathological examination of biopsy specimens. Biopsies were also taken for antibiotic susceptibility testing. All enrolled patients were treated with triple therapy consisting of clarithromycin, amoxicillin, and pantoprazole for 14 days. C-13 urea breath test was performed 6 weeks after completing the triple therapy to assess eradication and associated point mutations using real-time polymerase chain reaction (PCR).


RESULTS
H pylori was eradicated in 42.9% of diabetic patients and 79.3% of control patients, (P < 0.05). In type 2 diabetes mellitus patients, clarithromycin resistance was 64.3% (36/56), while in the control group, clarithromycin resistance was 35.7% (20/58) (P < 0.05). H pylori was eradicated in 14 (70%) of the 20 clarithromycin-susceptible diabetic patients and in only 10 (27.8%) of the 36 clarithromycin-resistant diabetic patients.


CONCLUSIONS
The H pylori eradication rate was significantly lower and clarithromycin resistance was significantly higher in type 2 diabetics. Alternative and new treatment protocols and antibiotic susceptibility testing are needed to achieve successful eradication rates.
Demir
Mehmet
M
Department of Gastroenterology, Baskent University Faculty of Medicine, Konya, Turkey.
Gokturk
Huseyin Savas
HS
Ozturk
Nevin Akcaer
NA
Arslan
Hande
H
Serin
Ender
E
Yilmaz
Ugur
U
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage / Q000627:therapeutic use; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077402:Pantoprazole; D016133:Polymerase Chain Reaction
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D000658:Amoxicillin; D000077402:Pantoprazole; D017291:Clarithromycin