Antibiotic treatments for Heliobacter pylori infections showed lower-than-accepted eradication rates in patients previously treated for COVID-19, according to the results of a randomized trial published last week in BMC Infectious Diseases.
In the trial, conducted in Egypt from Mar 21, 2021, to Sep 30, 2021, investigators enrolled 270 patients with newly diagnosed H pylori infections who had been treated for COVID-19 more than 3 months before enrollment. The patients were randomized to receive the first-line treatment of clarithromycin, esomeprazole, and amoxicillin or the alternative regimen of levofloxacin, esomeprazole, and amoxicillin. H pylori is the main causative organism of chronic gastritis, peptic ulcer disease, and gastric carcinoma.
A total of 116 patients in the clarithromycin group and 117 patients in the levofloxacin group were assessed. The eradication rates in the intention-to-treat and per-protocol analyses were 55.56% and 64.66%, respectively, in the clarithromycin arm and 64.44% and 74.36%, respectively, in the levofloxacin arm. While the eradication rate using levofloxacin was higher than that of the clarithromycin-based regimen, the difference did not reach statistical significance, and both regimens had an unacceptable rate of eradication.
Although they did not document which type of antibiotics the patients had been treated with for COVID-19, the investigators suggest the extensive use of azithromycin (which has cross-resistance with clarithromycin) and levofloxacin to treat COVID-19 patients may have resulted in the accumulation of mutations in H pylori—a bacterium present in 50% to 75% of the world's population—that confer resistance.
They say the findings should "raise the alarm" about the impact that widespread antibiotic use for COVID-19, particularly during the first year of the pandemic, has had on antibiotic resistance. "This rising resistance can adversely impact the costs of H. pylori treatment and increase the risk of H. pylori related diseases," they wrote. "Further studies enrolling a larger number of patients with molecular and genetic testing are needed to elucidate the exact mechanism of antibiotic resistance of H. pylori in such patients."