PMID- 31882676 OWN - NLM STAT- MEDLINE DCOM- 20201207 LR - 20210110 IS - 2045-2322 (Electronic) IS - 2045-2322 (Linking) VI - 9 IP - 1 DP - 2019 Dec 27 TI - High prevalence of clarithromycin resistance and effect on Helicobacter pylori eradication in a population from Santiago, Chile: cohort study and meta-analysis. PG - 20070 LID - 10.1038/s41598-019-56399-7 [doi] LID - 20070 AB - Helicobacter pylori (H. pylori) eradication using standard triple therapy (STT) with proton pump inhibitors (PPI), amoxicillin and clarithromycin (CLA) has been the standard in Latin America. However, CLA resistance is a rising problem affecting eradication rates. Genetic polymorphisms of CYP2C19, a PPI metabolizer may also affect eradication. The primary aims of this study were to evaluate the effect of clarithromycin resistance on H. pylori eradication in a population from Santiago, and to establish the pooled clarithromycin resistance in Santiago, Chile. Symptomatic adult patients attending a tertiary hospital in Santiago were recruited for this study. CLA resistance and the polymorphisms of CYP2C19 were determined on DNA extracted from gastric biopsies, using PCR. The STT was indicated for 14 days and eradication was determined by a urea breath test 4-6 weeks after therapy. A meta-analysis of CLA resistance studies among adult residents in Santiago was performed. Seventy-three out of 121 consecutive patients had positive rapid urease test (RUT) and received STT. Sixty-nine patients (95%) completed the study. The H. pylori eradication rate was 63% and the prevalence of CLA resistance was 26%. According to the CYP2C19 polymorphisms, 79.5% of the RUT-positive patients were extensive metabolizers. Multivariable analyses showed that only CLA resistance was significantly and inversely associated with failure of eradication (OR: 0.13; 95% confidence interval [95% CI], 0.04-0.49). A meta-analysis of two previous studies and our sample set (combined n = 194) yielded to a pooled prevalence of CLA resistance of 31.3% (95% CI 23.9-38.7). Our study shows that CLA resistance is associated with failure of H. pylori eradication. Given the high pooled prevalence of CLA resistance, consideration of CLA free therapies in Santiago is warranted. We could recommend bismuth quadruple therapy or high-dose dual therapy, according to bismuth availability. Further studies need to evaluate the best therapy. FAU - Arenas, A AU - Arenas A AUID- ORCID: 0000-0002-0901-966X AD - Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile. afarenas@gmail.com. FAU - Serrano, C AU - Serrano C AD - Departamento de Gastroenterologia y Nutricion pediatrica, Pontificia Universidad Catolica de Chile, Santiago, Chile. FAU - Quinones, L AU - Quinones L AD - Laboratorio CQF, Departamento de Oncologia Basico-Clinica, Facultad de Medicina, Universidad de Chile, Santiago, Chile. FAU - Harris, P AU - Harris P AD - Departamento de Gastroenterologia y Nutricion pediatrica, Pontificia Universidad Catolica de Chile, Santiago, Chile. FAU - Sandoval, M AU - Sandoval M AUID- ORCID: 0000-0001-6013-0032 AD - Departamento de Gastroenterologia y Nutricion pediatrica, Pontificia Universidad Catolica de Chile, Santiago, Chile. FAU - Lavanderos, M AU - Lavanderos M AD - Laboratorio CQF, Departamento de Oncologia Basico-Clinica, Facultad de Medicina, Universidad de Chile, Santiago, Chile. FAU - Sepulveda, R AU - Sepulveda R AD - Departamento de Medicina Interna, Universidad de la Frontera, Frontera, Chile. FAU - Maquilon, S AU - Maquilon S AD - Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile. FAU - Echeverria, A AU - Echeverria A AD - Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile. FAU - Rios, C AU - Rios C AUID- ORCID: 0000-0001-9767-4770 AD - Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile. FAU - Fuentes-Lopez, E AU - Fuentes-Lopez E AUID- ORCID: 0000-0002-0141-0226 AD - Departamento de Ciencias de la Salud, Facultad de Medicina. Pontificia Universidad Catolica de Chile, Santiago, Chile. FAU - Rojas, L AU - Rojas L AD - Departamento de Medicina Interna, Escuela de Medicina. Pontificia Universidad Catolica de Chile, Santiago, Chile. FAU - Jorquera, A AU - Jorquera A AD - Servicio de Endoscopia, Hospital de Curanilahue, Curanilahue, Chile. FAU - Pizarro, M AU - Pizarro M AD - Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile. FAU - Camargo, M C AU - Camargo MC AD - Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA. FAU - Riquelme, A AU - Riquelme A AD - Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile. AD - Departamento de Ciencias de la Salud, Facultad de Medicina. Pontificia Universidad Catolica de Chile, Santiago, Chile. LA - eng PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't DEP - 20191227 PL - England TA - Sci Rep JT - Scientific reports JID - 101563288 RN - 0 (Anti-Bacterial Agents) RN - H1250JIK0A (Clarithromycin) RN - U015TT5I8H (Bismuth) SB - IM MH - Adult MH - Anti-Bacterial Agents/*pharmacology MH - Bismuth/therapeutic use MH - Chile/epidemiology MH - Clarithromycin/*pharmacology MH - Cohort Studies MH - Drug Resistance, Bacterial/drug effects MH - Female MH - Helicobacter Infections/*drug therapy/epidemiology/microbiology MH - Helicobacter pylori/*drug effects MH - Humans MH - Male MH - Middle Aged MH - Prevalence MH - Prospective Studies PMC - PMC6934858 COIS- The authors declare no competing interests. EDAT- 2019/12/29 06:00 MHDA- 2020/12/15 06:00 PMCR- 2019/12/27 CRDT- 2019/12/29 06:00 PHST- 2019/05/08 00:00 [received] PHST- 2019/12/11 00:00 [accepted] PHST- 2019/12/29 06:00 [entrez] PHST- 2019/12/29 06:00 [pubmed] PHST- 2020/12/15 06:00 [medline] PHST- 2019/12/27 00:00 [pmc-release] AID - 10.1038/s41598-019-56399-7 [pii] AID - 56399 [pii] AID - 10.1038/s41598-019-56399-7 [doi] PST - epublish SO - Sci Rep. 2019 Dec 27;9(1):20070. doi: 10.1038/s41598-019-56399-7.