title: Five-year sequential changes in secondary antibiotic resistance of Helicobacter pylori in Taiwan.
abstract: OBJECTIVE
  To determine changes in the antibiotic resistance of Helicobacter pylori (H. pylori) in southern Taiwan after failure of first-line standard triple therapy.
  
  
  METHODS
  We analyzed 137 H. pylori-infected isolates from patients who experienced eradication failure after standard first-line triple therapy from January 2010 to December 2014. The H. pylori strains were tested for susceptibility to amoxicillin, clarithromycin, levofloxacin, metronidazole and tetracycline using the E-test method. The minimal inhibitory concentration (MIC) was determined by the agar dilution test. MIC values of ≥ 0.5, ≥ 1, ≥ 1, ≥ 4 and ≥ 8 mg/L were considered to be the resistance breakpoints for amoxicillin, clarithromycin, levofloxacin, tetracycline and metronidazole, respectively.
  
  
  RESULTS
  A high resistance rate was found for clarithromycin (65%-75%) and metronidazole (30%-40%) among patients who failed first-line standard therapy. The resistance levels to amoxicillin and tetracycline remained very low; however, levofloxacin resistance was as high as 37.5% in 2010 but did not increase any further during the past 5 years. The rates of resistance to these antibiotics did not show a statistically significant upward or downward trend.
  
  
  CONCLUSIONS
  Antibiotic resistance of H. pylori remains a problem for the effective eradication of this pathogen and its associated diseases in Taiwan. High clarithromycin resistance indicated that this antibiotic should not be prescribed as a second-line H. pylori eradication therapy. Moreover, levofloxacin-based second-line therapy should be used cautiously, and the local resistance rates should be carefully monitored.
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: I-Ting
authors.initials: IT
authors.lastname: Wu
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Seng-Kee
authors.initials: SK
authors.lastname: Chuah
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Chen-Hsiang
authors.initials: CH
authors.lastname: Lee
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Liang
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Lung-Sheng
authors.initials: LS
authors.lastname: Lu
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Yuan-Hung
authors.initials: YH
authors.lastname: Kuo
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Yi-Hao
authors.initials: YH
authors.lastname: Yen
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Ming-Luen
authors.initials: ML
authors.lastname: Hu
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Yeh-Pin
authors.initials: YP
authors.lastname: Chou
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Shih-Cheng
authors.initials: SC
authors.lastname: Yang
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Chung-Mou
authors.initials: CM
authors.lastname: Kuo
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Chung-Huang
authors.initials: CH
authors.lastname: Kuo
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Chun-Chih
authors.initials: CC
authors.lastname: Chien
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Yu-Shao
authors.initials: YS
authors.lastname: Chiang
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Shue-Shian
authors.initials: SS
authors.lastname: Chiou
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Tsung-Hui
authors.initials: TH
authors.lastname: Hu
authors.affiliation: I-Ting Wu, Seng-Kee Chuah, Chih-Ming Liang, Lung-Sheng Lu, Yuan-Hung Kuo, Yi-Hao Yen, Ming-Luen Hu, Yeh-Pin Chou, Shih-Cheng Yang, Chung-Mou Kuo, Chung-Huang Kuo, Shue-Shian Chiou, Tsung-Hui Hu, Wei-Chen Tai, Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Tai
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001706:Biopsy; D017291:Clarithromycin / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D004352:Drug Resistance, Microbial; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D064704:Levofloxacin / Q000627:therapeutic use; D008795:Metronidazole / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D013624:Taiwan; D013752:Tetracycline / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D064704:Levofloxacin; D000658:Amoxicillin; D013752:Tetracycline; D017291:Clarithromycin
keywords: Antibiotic resistance; Failed first-line therapy; Five-year sequential changes; Helicobacter pylori; Southern Taiwan