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Clarithromycin-containing triple therapy for Helicobacter pylori eradication is inducing increased long-term resistant bacteria communities in the gut
  1. Olga Sjomina1,2,
  2. Reinis Vangravs1,
  3. Elīna Ļeonova1,2,
  4. Inese Poļaka1,
  5. Dārta Pūpola1,
  6. Kristaps Čivkulis1,
  7. Aleksandra Jeniceka2,
  8. Sergejs Paršutins1,
  9. Ilmārs Stonāns1,
  10. Jin Young Park3,
  11. Lars Engstrand4,
  12. Mārcis Leja1,2
  1. 1 Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
  2. 2 Faculty of Medicine, University of Latvia, Riga, Latvia
  3. 3 International Agency for Research on Cancer, Lyon, France
  4. 4 Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Prof Mārcis Leja, University of Latvia Institute of Clinical and Preventive Medicine, Riga, LV-1079, Latvia; marcis.leja{at}

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The current European guidelines (Maastricht VI/Florence consensus report) on the management of Helicobacter pylori infection1 recommend population-based H. pylori screening programmes for asymptomatic individuals in the general population to eradicate the microorganism for gastric cancer prevention. However, this is expected to result in a considerable increase in antibiotic use2 as half of the global population are estimated to be infected.3 Therefore, the guidelines suggest that caution is required in choosing the appropriate antibiotics to minimise antimicrobial resistance.1

The importance of gut resistome induction following H. pylori eradication therapies has been debated for years, and the available information is controversial; the general thought is that normal gut microbiota is restored 3–6 months after antibiotic treatment.4

Therefore, we conducted a randomised controlled clinical trial as part of the GISTAR study5 in Latvia by evaluating alterations in gut microbiota before and 6 months after administering two treatment regimens for H. pylori eradication. Stool samples were collected from 158 patients, of whom 27 received high-dose amoxicillin/bismuth therapy, including bismuth subcitrate 240 mg two times per day, amoxicillin 1000 mg three times per day, and esomeprazole 40 mg two times per day for 14 days, and 31 received clarithromycin 500 mg, amoxicillin 1000 mg and esomeprazole 40 mg, all two times per day for 14 days. The control group, which included 50 subjects, did not receive any treatment. The participants’ median age …

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  • Contributors All the authors fulfilled the ICMJE four authorship criteria. There is no one else who fulfils the criteria that has been excluded as an author. All authors gave permission to be included. OS is responsible for the overall content as guarantor. The guarantor accepts full responsibility for this work. OS: planned the study, organised data collection, interpreted the results, drafted the manuscript. RV: gathered data, conducted the data analysis, interpreted the results, drafted the results. EL: conducted data collection. IP: conducted data statistical analysis and interpretation. DP: gathered data, conducted data analysis. KC: gathered data, conducted data analysis, interpreted the results. AJ: communication with the respondents, data collection. SP: organised data storage, data analysis, IT support for data storage. IS: organised the study performance, managed the organisation of the research process. JYP: drafted the manuscript and edited it for clarity, style and grammar. LE: interpreted data and edited it for clarity. ML: designed the study methodology and developed data collection and analysis plan, formulated the research questions, edited the drafted manuscript.

  • Funding The study was supported by the ERDF (European Regional Development Fund) in Latvia, project No. 'Optimisation of H. pylori eradication therapy for population-based gastric cancer prevention'.

  • Disclaimer Where authors are identified as personnel of the International Agency for Research on Cancer/WHO, the authors alone are responsible for the views expressed in this article, and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/WHO.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.