Management of Antibiotic-Resistant Helicobacter pylori Infection: Perspectives from Vietnam

Abstract

Antibiotic resistance is the most important factor leading to the failure of eradication regimens. This review focuses on the prevalence of Helicobacter pylori primary and secondary resistance to clarithromycin, metronidazole, amoxicillin, levofloxacin, tetracycline, and multidrug in Vietnam. We searched the PubMed, EMBASE, Vietnamese National Knowledge Infrastructure, and Vietnamese Biomedical databases from January 2000 to December 2016. The search terms included the following: H. pylori infection, antibiotic (including clarithromycin, metronidazole, amoxicillin, levofloxacin, tetracycline, and multidrug) resistance in Vietnam. The data were summarized in an extraction table and analyzed manually. Finally, Excel 2007 software was used to create charts. Ten studies (three studies in English and seven in Vietnamese) were included in this review. A total of 308, 412, 523, 408, 399, and 268 H. pylori strains were included in this review to evaluate the prevalence of H. pylori primary resistance to amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and multidrug resistance, respectively. Overall, the primary resistance rates of amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and multidrug resistance were 15.0%, 34.1%, 69.4%, 27.9%, 17.9% and 48.8%, respectively. Secondary resistance rates of amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and multidrug resistance were 9.5%, 74.9%, 61.5%, 45.7%, 23.5% and 62.3%, respectively. In Vietnam, primary and secondary resistance to H. pylori is increasing over time and affects the effectiveness of H. pylori eradication.

Keywords: Amoxicillin; Bismuth; Clarithromycin; Helicobacter pylori; Metronidazole.

Fig. 1

Map of Vietnam with three different regions: North, Central, and South. Note: North Vietnam includes northwestern, northeast and Red River Delta areas. Central Vietnam includes north central coast, south central coast and central highlands. South Vietnam includes southeastern and Mekong River Delta areas. Reprinted with the permission of Nations Online Project.

Fig. 2

Average rate of primary resistance with Helicobacter pylori in Vietnam from 2001 to 2016.

Fig. 3

Multidrug resistance patterns of Helicobacter pylori in Vietnam. C+M, clarithromycin+metronidazole; C+L, clarithromycin+levofloxacin; C+T, clarithromycin+tetracycline; M+L, metronidazole+levofloxacin; M+T, metronidazole+tetracycline; L+T, levofloxacin+ tetracycline.