Concerns About Clarithromycin Resistance in H. Pylori Treatment

Q: Concerns About Clarithromycin Resistance in H. Pylori Treatment

Hello： Antibiotics do not develop resistance simply because they have been used once. <br>Therefore, it is sufficient to choose one provider. <br>Changhua Hospital cares about your health.

I have taken Clarithromycin for 4 years and 10 months, and now there are duplicate medications in the three-in-one combination?

First, I would like to mention that I took Clarithromycin (Klaricid) prescribed by a pulmonologist for 4 days (250 mg twice daily) nearly 4 years and 10 months ago (February 2011).
Recently, I underwent an endoscopy that revealed gastroesophageal reflux and mild esophagitis, but no gastric ulcers.
However, Helicobacter pylori was detected, and my doctor recommended that I first treat the H.
pylori infection.
He prescribed a triple therapy regimen consisting of Lansoprazole (30 mg, one tablet once), Amoxicillin (250 mg, four tablets once), and Clarithromycin (500 mg, one tablet once), all to be taken twice daily before meals for seven days.
I would like to ask if the Clarithromycin I took previously might have led to antibiotic resistance, which could result in the failure of this triple therapy.

Additionally, I have not started the medication yet; I just picked it up.
Out of concern regarding potential antibiotic resistance from my previous use of Clarithromycin, I consulted another hospital, where the doctor prescribed a different triple therapy regimen that seems to be less common: Lansoprazole (30 mg, only once in the morning before meals), Amoxicillin (500 mg, two tablets once), and Metronidazole (250 mg, two tablets once).
In this case, the acid reducer is only taken once in the morning before meals (not in the evening), and this regimen is to be taken after meals for a total of fourteen days.

Again, I have not started this regimen either; I just picked it up.
Should I opt for this fourteen-day treatment instead? I understand that I can only choose one regimen.
Thank you, doctor, for addressing my concerns, and I appreciate your help!

windows_jiancha, 30~39 year old female. Ask Date: 2015/12/02

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello: Antibiotics do not develop resistance simply because they have been used once.
Therefore, it is sufficient to choose one provider.
Changhua Hospital cares about your health.

Reply Date: 2015/12/02

More Info

When it comes to the treatment of Helicobacter pylori (H. pylori) infection, concerns about antibiotic resistance, particularly regarding Clarithromycin, are indeed valid. Clarithromycin is a macrolide antibiotic that has been widely used in the treatment of H. pylori infections, often in combination with other medications such as proton pump inhibitors (PPIs) and other antibiotics like Amoxicillin.
Your previous use of Clarithromycin nearly five years ago raises a pertinent question about the potential for developing resistance to this antibiotic. It is important to note that antibiotic resistance can develop when antibiotics are used repeatedly or improperly, leading to a situation where the bacteria no longer respond to the treatment. However, the development of resistance is not guaranteed after a single course of treatment, especially if it was several years ago.
Studies have shown that resistance rates to Clarithromycin can vary significantly depending on geographic location and local prescribing practices. In some areas, the resistance rates can be as high as 20-30%, which can indeed impact the effectiveness of standard triple therapy regimens that include Clarithromycin. If resistance is present, it can lead to treatment failure, necessitating alternative therapies.

In your case, the first treatment regimen prescribed to you includes Lansoprazole, Amoxicillin, and Clarithromycin. If there is a concern about potential resistance to Clarithromycin, it is reasonable to consider the alternative regimen you received from the second physician, which includes Lansoprazole, Amoxicillin, and Metronidazole. Metronidazole is often used as an alternative to Clarithromycin in cases where resistance is suspected or confirmed.

The decision on which regimen to follow should ideally be based on local resistance patterns, your medical history, and any previous treatments you have undergone. If you have concerns about Clarithromycin resistance, it may be prudent to opt for the second regimen, especially since it is designed to be effective against H. pylori without relying on Clarithromycin.

In addition to the choice of antibiotics, it is crucial to adhere to the full course of treatment as prescribed. Incomplete treatment can also contribute to the development of resistance. Furthermore, it is advisable to follow up with your healthcare provider after completing the treatment to ensure that the H. pylori infection has been eradicated, which can be confirmed through breath, stool, or endoscopic biopsy tests.

In summary, while your previous use of Clarithromycin raises valid concerns about potential resistance, the decision on which treatment regimen to follow should be made in consultation with your healthcare provider, taking into account local resistance patterns and your individual medical history. If resistance is a concern, the alternative regimen with Metronidazole may be a more effective choice for treating your H. pylori infection. Always ensure to communicate openly with your healthcare provider about your concerns and any side effects you may experience during treatment.

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