Analysis of antimicrobial susceptibility and virulence factors in Helicobacter pylori clinical isolates

BACKGROUND: In this study, we evaluated the prevalence of primary resistance of Brazilian H. pylori isolates to metronidazole, clarithromycin, amoxicillin, tetracycline, and furazolidone. In addition, the vacA, iceA, cagA and cagE genotypes of strains isolated from Brazilian patients were determined and associated with clinical data in an effort to correlate these four virulence markers and antibiotic resistance. METHODS: H. pylori was cultured in 155 H. pylori-positive patients and MICs for metronidazole, clarithromycin, amoxicillin, tetracycline, and furazolidone were determined by the agar dilution method. Genomic DNA was extracted, and allelic variants of vacA, iceA, cagA and cagE were identified by the polymerase chain reaction. RESULTS: There was a strong association between the vacA s1/cagA -positive genotype and peptic ulcer disease (OR = 5.42, 95% CI 2.6–11.3, p = 0.0006). Additionally, infection by more virulent strains may protect against GERD, since logistic regression showed a negative association between the more virulent strain, vacA s1/cagA-positive genotype and GERD (OR = 0.26, 95% CI 0.08–0.8, p = 0.03). Resistance to metronidazole was detected in 75 patients (55%), to amoxicillin in 54 individuals (38%), to clarithromycin in 23 patients (16%), to tetracycline in 13 patients (9%), and to furazolidone in 19 individuals (13%). No significant correlation between pathogenicity and resistance or susceptibility was detected when MIC values for each antibiotic were compared with different vacA, iceA, cagA and cagE genotypes. CONCLUSION: The analysis of virulence genes revealed a specific association between H. pylori strains and clinical outcome, furthermore, no significant association was detected among pathogenicity and resistance or susceptibility

Short-term triple therapy with azithromycin for Helicobacter pylori eradication: Low cost, high compliance, but low efficacy

<p>Abstract</p> <p>Background</p> <p>The Brazilian consensus recommends a short-term treatment course with clarithromycin, amoxicillin and proton-pump inhibitor for the eradication of <it>Helicobacter pylori </it>(<it>H. pylori)</it>. This treatment course has good efficacy, but cannot be afforded by a large part of the population. Azithromycin, amoxicillin and omeprazole are subsidized, for several aims, by the Brazilian federal government. Therefore, a short-term treatment course that uses these drugs is a low-cost one, but its efficacy regarding the bacterium eradication is yet to be demonstrated. The study's purpose was to verify the efficacy of <it>H. pylori </it>eradication in infected patients who presented peptic ulcer disease, using the association of azithromycin, amoxicillin and omeprazole.</p> <p>Methods</p> <p>Sixty patients with peptic ulcer diagnosed by upper digestive endoscopy and <it>H. pylori </it>infection documented by rapid urease test, histological analysis and urea breath test were treated for six days with a combination of azithromycin 500 mg and omeprazole 20 mg, in a single daily dose, associated with amoxicillin 500 mg 3 times a day. The eradication control was carried out 12 weeks after the treatment by means of the same diagnostic tests. The eradication rates were calculated with 95% confidence interval.</p> <p>Results</p> <p>The eradication rate was 38% per intention to treat and 41% per protocol. Few adverse effects were observed and treatment compliance was high.</p> <p>Conclusion</p> <p>Despite its low cost and high compliance, the low eradication rate does not allow the recommendation of the triple therapy with azithromycin as an adequate treatment for <it>H. pylori </it>infection.</p

Avaliação da resistencia primaria a antimicrobianos em linhagens de helicobacter pylori, isoladas de pacientes da região de Bragança Paulista

Orientador: Jose Pedrazzoli JuniorDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: A infecção pelo Helicobacter pylori é associada com uma variedade de doenças digestivas e apresenta alta prevalência em países em desenvolvimento, apesar de poucos dados sobre a susceptibilidade da bactéria aos antimicrobianos comumente usados nos esquemas de erradicação nesses países. O objetivo do presente estudo foi avaliar a resistência do Helicobacter pylori ao metronidazol, claritromicina, amoxicilina, tetraciclina e furazolidona em pacientes dispépticos no Brasil. Noventa pacientes dispépticos foram avaliados. A resistência foi avaliada pelo teste de diluição em ágar. A resistência ao metronidazol foi detectada em 38 pacientes (42%); a amoxicilina em 26 indivíduos (29%); a claritromicina em 6 pacientes (7%); a tetraciclina em 6 pacientes (7%); e à furazolidona em 4 indivíduos (4%). Treze culturas foram resistentes a 2 agentes antimicrobianos, e oito foram resistentes a três agentes. Os resultados encontrados confirmam a necessidade da realização de cultura e teste de susceptibilidade para a definição dos padrões de resistência em determinadas áreas geográficas para o uso generalizado de um esquema de erradicação da infecção pelo Helicobacter pyloriAbstract: Helicobacter pylori infection is associated with a wide range of digestive diseases and is very prevalent in developing countries, although few data exist on the susceptibility of H pylori to antimicrobials commonly used in eradication schedules in these countries. The aim of this study was to evaluate the resistance of h. pylori to metronidazole, clarithromycin, amoxicillin, tetracyclin, and furazolidone in dyspeptic Brazilian patients. Ninety consecutive H pylori-positive patients was enrolled. Resistance was evaluated by an agar diluition test. Resistance to metronidazole was detected in 38 patients (42%); to amoxicillin in 26 individuais (29%); to clarithromycin in 6 patients (7%); to tetracycline in 6 patients (7%); and to furazolidone in 4 individuais (4%). Thirteen strains were resistant to two agents, and eight strains were resistant to three antimicrobials. These results confirm the need for culture and susceptibility testing to define H. pylori resistance patterns in particular geographical areas before the general use of an eradication schedule. They also suggest the possibility of resistance to such antimicrobials as amoxicillin or tetracycline in geographical areas with a high prevalence of H. pylori and still not fully evaluated for antimicrobial susceptibilityMestradoMedicina InternaMestre em Ciências Médica

Double-blind, randomized, double-dummy clinical trial comparing the efficacy of ketorolac trometamol and naproxen for acute low back pain

P&eacute;rola Grinberg Plapler,1 Morton Aaron Scheinberg,2 Christina da Cunha Ecclissato,3 Monalisa Fernanda Bocchi de Oliveira,3 Roberto Bleuel Amazonas31Orthopedic and Traumatology Institute of Clinical Hospital, University of S&atilde;o Paulo, 2Clinical Research Center Hospital AACD, S&atilde;o Paulo, 3NC Group Medical Affairs, Hortol&acirc;ndia, S&atilde;o Paulo, Brazil Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common type of medication used in the treatment of acute pain. Ketorolac trometamol (KT) is a nonnarcotic, peripherally acting nonsteroidal anti-inflammatory drug with analgesic effects comparable to certain opioids.Objective: The aim of this study was to compare the efficacy of KT and naproxen (NA) in the treatment of acute low back pain (LBP) of moderate-to-severe intensity.Patients and methods: In this 10-day, Phase III, randomized, double-blind, double-dummy, noninferiority trial, participants with acute LBP of moderate-to-severe intensity as determined through a visual analog scale (VAS) were randomly assigned in a 1:1 ratio to receive sublingual KT 10&nbsp;mg three times daily or oral NA 250&nbsp;mg three times daily. From the second to the fifth day of treatment, if patient had VAS &gt;40&nbsp;mm, increased dosage to four times per day was allowed. The primary end point was the reduction in LBP as measured by VAS. We also performed a post hoc superiority analysis.Results: KT was not inferior to NA for the reduction in LBP over 5&nbsp;days of use as measured by VAS scores (P=0.608 for equality of variance; P=0.321 for equality of means) and by the Roland&ndash;Morris Disability Questionnaire (P=0.180 for equality of variance test; P=0.446 for equality of means) using 95% confidence intervals. The percentage of participants with improved pain relief 60&nbsp;minutes after receiving the first dose was higher in the KT group (24.2%) than in the NA group (6.5%; P=0.049). The most common adverse effects were heartburn, nausea, and vomiting.Conclusion: KT is not inferior in efficacy and delivers faster pain relief than NA.Keywords: ketorolac trometamol, naproxen, acute low back pain, nonsteroidal anti-inflammatory drug