Journal of Antimicrobial Chemotherapy (1999) 44, 629-640
© 1999 The British Society for Antimicrobial Chemotherapy
Comparative effects of omeprazole, amoxycillin plus metronidazole versus omeprazole, clarithromycin plus metronidazole on the oral, gastric and intestinal microflora in Helicobacter pylori-infected patients
a Department of Immunology, Microbiology, Pathology and Infectious Diseases b Centre of Gastroenterology, Huddinge University Hospital, Karolinska Institute, Stockholm c University College of South Stockholm, Stockholm, Sweden
Fourteen patients with Helicobacter pylori infection were treated with 20 mg omeprazole, 1 g amoxycillin and 400 mg metronidazole bd for 7 days (OAM), and 16 patients were treated with 20 mg omeprazole, 250 mg clarithromycin and 400 mg metronidazole bd for 7 days (OCM). Saliva, gastric biopsies and faecal samples were collected before, during (day 7) and 4 weeks after treatment in order to analyse alterations of the normal microflora and to determine antimicrobial susceptibility. Both treatment regimens resulted in marked quantitative and qualitative alterations. A selection of resistant streptococcal strains were noticed in both treatment groups, most apparent in the OCM group where a shift from susceptible to resistant strains was recorded. In the OAM group, six patients had overgrowth of resistant enterobacteriaceae during treatment compared with none in the OCM group, in the gastric microflora. The MICs for Enterococcus spp. and Enterobacteriaceae in faeces increased significantly during treatment in both groups. Nine patients in the OAM group became intestinally colonized by yeasts during treatment. The total anaerobic microflora was strongly suppressed in both treatment groups, although most pronounced in the OCM group, where the frequency of clarithromycin-resistant bacteroides strains increased from 2 to 76% during treatment, and remained at 59% 4 weeks post-treatment. Even if the treatment outcome was better in the OCM group (100%) than in the OAM group (71%), the amoxycillin-based treatment might be preferable from an ecological point of view, since the qualitative alterations in terms of emergence and persistence of resistant strains seemed to be most pronounced in the clarithromycin-treated group.
* Correspondence address. F82, Huddinge University Hospital, S-131 86 Huddinge, Sweden. Tel:+46-8-585-878-38; Fax: +46-8-711-3918; E-mail: carl.erik.nord{at}impi.ki.se
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C.-W. Lee, B. Rickman, A. B. Rogers, S. Muthupalani, S. Takaishi, P. Yang, T. C. Wang, and J. G. Fox Combination of Sulindac and Antimicrobial Eradication of Helicobacter pylori Prevents Progression of Gastric Cancer in Hypergastrinemic INS-GAS Mice Cancer Res., October 15, 2009; 69(20): 8166 - 8174. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Dicksved, M. Lindberg, M. Rosenquist, H. Enroth, J. K. Jansson, and L. Engstrand Molecular characterization of the stomach microbiota in patients with gastric cancer and in controls J. Med. Microbiol., April 1, 2009; 58(4): 509 - 516. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y.-C. Lee, J.-M. Liou, C.-Y. Wu, and J.-T. Lin Review: Eradication of Helicobacter pylori to prevent gastroduodenal diseases: Hitting more than one bird with the same stone Therapeutic Advances in Gastroenterology, September 1, 2008; 1(2): 111 - 120. [Abstract] [PDF]
|
|
|
|
|
|
C.-W. Lee, B. Rickman, A. B. Rogers, Z. Ge, T. C. Wang, and J. G. Fox Helicobacter pylori Eradication Prevents Progression of Gastric Cancer in Hypergastrinemic INS-GAS Mice Cancer Res., May 1, 2008; 68(9): 3540 - 3548. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. M. Bik, P. B. Eckburg, S. R. Gill, K. E. Nelson, E. A. Purdom, F. Francois, G. Perez-Perez, M. J. Blaser, and D. A. Relman Molecular analysis of the bacterial microbiota in the human stomach PNAS, January 17, 2006; 103(3): 732 - 737. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Tanaka, Y. Fukuda, S. Shintani, K. Hori, T. Tomita, T. Ohkusa, T. Matsumoto, and H. Miwa Influence of antimicrobial treatment for Helicobacter pylori infection on the intestinal microflora in Japanese macaques J. Med. Microbiol., March 1, 2005; 54(3): 309 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. F. Berg, J. H. T. Tjhie, G.-J. Scheffer, M. F. Peeters, P. H. J. van Keulen, J. A. J. W. Kluytmans, and E. E. Stobberingh Emergence and Persistence of Macrolide Resistance in Oropharyngeal Flora and Elimination of Nasal Carriage of Staphylococcus aureus after Therapy with Slow-Release Clarithromycin: a Randomized, Double-Blind, Placebo-Controlled Study Antimicrob. Agents Chemother., November 1, 2004; 48(11): 4183 - 4188. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. L P Beales, H. K Parsons, D. S Sanders, M. J Carter, A. J Lobo, and T. Watts Management of Helicobacter pylori infection BMJ, March 9, 2002; 324(7337): 614 - 614. [Full Text]
|
|
|
|
 |
|
 R J Owen Molecular testing for antibiotic resistance in Helicobacter pylori Gut, March 1, 2002; 50(3): 285 - 289. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Edlund, G. Alvan, L. Barkholt, F. Vacheron, and C. E. Nord Pharmacokinetics and comparative effects of telithromycin (HMR 3647) and clarithromycin on the oropharyngeal and intestinal microflora J. Antimicrob. Chemother., November 1, 2000; 46(5): 741 - 749. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-J. MONSTEIN, A. TIVELJUNG, C.H. KRAFT, K. BORCH, and J. JONASSON Profiling of bacterial flora in gastric biopsies from patients with Helicobacter pylori-associated gastritis and histologically normal control individuals by temperature gradient gel electrophoresis and 16S rDNA sequence analysis J. Med. Microbiol., September 1, 2000; 49(9): 817 - 822. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G G. Rao, J O'Donohue, C S M. Rao, H Fidler, M C Bateson, V. Savarino, M. Neri, and S. Vigneri Treatment of Helicobacter pylori infection BMJ, June 3, 2000; 320(7248): 1540 - 1540. [Full Text]
|
|