High antibiotic resistance rates in Helicobacter pylori strains in Turkey over 20 years: implications for gastric disease treatment.

OBJECTIVE: Helicobacter pylori (Hp) eradication therapy is crucial for preventing the development of gastritis, peptic ulcers, and gastric cancer. An increase in resistance against antibiotics used in the eradication of Hp is remarkable. This meta-analysis aims to examine the resistance rates of Hp strains isolated in Turkey over the last 20 years against clarithromycin (CLR), metronidazole (MTZ), levofloxacin (LVX), tetracycline (TET), and amoxicillin (AMX) antibiotics. BASIC METHODS: Literature search was carried out in electronic databases, by searching articles published in Turkish and English with the keywords ' helicobacter pylori ' or 'Hp' and 'antibiotic resistance' and 'Turkey'. That meta-analysis was carried out using random-effect model. First, the 20-year period data between 2002 and 2021 in Turkey were planned to be analyzed. As a second stage, the period between 2002 and 2011 was classified as Group 1, and the period between 2012 and 2021 as Group 2 for analysis, with the objective of revealing the 10-year temporal variation in antibiotic resistance rates. MAIN RESULTS: In gastric biopsy specimens, 34 data from 29 studies were included in the analysis. Between 2002-2021, CLR resistance rate was 30.9% (95% CI: 25.9-36.2) in 2615 Hp strains. Specifically, in Group 1, the CLR resistance rate was 31% in 1912 strains, and in Group 2, it was 30.7% in 703 strains. The MTZ resistance rate was found to be 31.9% (95% CI: 19.8-45.4) in 789 strains, with rates of 21.5% in Group 1 and 46.6% in Group 2. The overall LVX resistance rate was 25.6%, with rates of 26.9% in Group 1 and 24.8% in Group 2. The 20-year TET resistance rate was 0.8%, with 1.50% in Group 1 and 0.2% in Group 2. The overall AMX resistance rate was 2.9%, 3.8% between 2002-2011, and 1.4% between 2012-2021. PRINCIPAL CONCLUSION: Hp strains in Turkey exhibit high resistance rates due to frequent use of CLR, MTZ, and LVX antibiotics. However, a significant decrease has been observed in TET and AMX resistance to Hp in the last 10 years. Considering the CLR resistance rate surpasses 20%, we suggest reconsidering the use of conventional triple drug therapy as a first-line treatment. Instead, we recommend bismuth-containing quadruple therapy or sequential therapies (without bismuth) for first-line treatment, given the lower rates of TET and AMX resistance. Regimens containing a combination of AMX, CLR, and MTZ should be given priority in second-line therapy. Finally, in centers offering culture and antibiogram opportunities, regulating the Hp eradication treatment based on the antibiogram results is obviously more appropriate.

Adherence to Treatment with Oral Nucleoside/Nucleotide Analogs in Patients with Chronic Hepatitis B.

Objectives: Adherence to antiviral treatment is important for treatment success and prevention of resistance. It was aimed to determine treatment adherence to nucleoside/nucleotide analogs and factors influencing on adherence. Methods: The study included 168 patients who received oral nucleoside/nucleotide analog with diagnosis of chronic hepatitis for at least 1 year. Data regarding demographic characteristics and missed drug were collected using a survey, while list of medication within prior year were extracted from pharmacy registry and Medication Possession Rate (MPR) was calculated. Results: There were 60 women (35.7%) and 108 men (64.3%) in the study. Mean age was calculated as 43.61±10.35 years. It was found that 29.2% of patients were non-adherent based on MPR (MPR<0.90). It was observed that adherence was improved on middle age. Treatment adherence was found to be higher in patients receiving medication due to disorders other than hepatitis B. It was found that there was no significant difference in adherence according to age, gender, occupation status, marital status, smoking or alcohol consumption habits, type of antiviral treatment, time and mode of drug intake, and biopsy finding at time of drug prescription. The most common cause was identified as forgetfulness for missed drug. Other common causes were inoccupation and alteration in daily routine. Conclusion: In our study, the treatment adherence determined by MPR was 70.8%. This rate was lower than those reported for chronic hepatitis B in the literature. It is important to monitor and encourage treatment adherence in patients with chronic hepatitis B by clinicians.