• Journal of Microbiology and Biotechnology
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• 제13권5호
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• pp.751-758
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• 2003

Mutations in the rdxA gene had been reported to be associated with metronidazole resistance in Helicobacter pylori. In this study, sensitivity to metronidazole, RAPD profiles, and DNA sequences of the rdxA gene of 32 local H. pylori isolates were analyzed. Of these, 13 were found to be resistant, while 19 were sensitive to metronidazole. Among the 32 isolates, 10 were paired isolates from the antrum and body of the stomach of individual patients. Interestingly, the RAPD profiles of isolates from individual patients were distinctly different from each other, whereas paired isolates from the same patient were identical regardless of their sensitivities to metronidazole. DNA sequences of the rdxA gene of all 32 isolates showed 95% to 97% homology when compared with the HP0954 locus of H. pylori 26695 genome. From the 19 metronidazole-sensitive strains, 10 (with $MIC{\le}0.5\;\mu\textrm{g}/ml$ metronidazole) were selected and induced to become metronidazole resistant by sequentially passaging through serial 2-fold increasing concentrations of metronidazole. Nine of the 10 induced paired isolates showed mutations in the rdxA sequences which resulted in truncated protein or changes in the translated amino acid sequences. However, the changes did not occur at any specific site in the DNA or amino acid sequences of the rdxA gene of all the isolates analyzed. The results show that the rdxA gene cannot be a definitive marker for metronidazole resistance in H. pylori isolates of an Asian population, and that other factors may contribute to resistance to metronidazole.

• 생명과학회지
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• 제15권6호
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• pp.955-960
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• 2005

메트로니다졸은 인체 위장질환의 원인균인 헬리코박터 파일로리를 박별하기위해 처방하는 주요 약제이다 그러나 인체로부터 분리한 헬리코박터 파일로리 균주는 메트로니다졸에 내성을 가지는 경우가 일반적이며, 이러한 내성원인은 이 균주의 염색체 상에 존재하는 두 종류의 nitroreductase 유전자인 rdxA와frxA 유전자가 비활성화됨에 따라 유발된다. 본 연구에서는 헬리코박터 파일로리 균에서 rdxA 유전자에 변이를 도입하여 메트로니다졸에 내성을 가지는 균주를 구축하여, 메트로니다졸 내성이 균주에 미치는 생물학적 영향을 관찰하고자 하였다. In vitro상에서 메트로니다졸 내성균주는 대조균과 비교하여 exponential phase에서는 거의 차이 없이 증식하였으나 stationary phase에서는 빠르게 생육활성을 잃는 것을 관찰할 수 있었다. 또한 생쥐를 이용한 동물 실험에서 메트로니다졸 내성균주는 생쥐의 위장 내에서 서식하는 능력을 상실함을 알 수 있었다. 그러나 이러한 생육 활성을 회복시켜주는 compensate템 mutation을 가진 균주를 쉽게 얻을 수 있었으며 이 균주는 생쥐에 감염시키면 위장 내에서 서식하는 능력을 회복함을 알 수 있었다.

• 약학회지
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• 제52권3호
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• pp.225-231
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• 2008

To clarify effects of the structural changes of Fur protein on the resistance to metronidazole (Mtz), the mutational analysis of structure and function of the protein in Helicobacter pylori (Hp) was undertaken. It was identified that some changes in Hp Fur protein resulted in increase of resistance to Mtz, and other changes resulted in decrease of resistance. Increase of Mtz resistance came from the enzyme's decreased ability of reducing prodrug Mtz to the form of bactericidal agent. Some sites that affects Mtz resistance (i) in Fur's N terminal extension, and (ii) in its central region, which links DNA binding and Fe-binding modules were identified. It was also found that the addition of FLAG tag to Fur's C terminus also significantly impairs Fur function.

• 생명과학회지
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• 제17권5호
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• pp.723-727
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• 2007

본 연구는 H. pylori에서 metronidazole내성에 관여하는 유전자를 발견하고 이들 유전자들의 상호 조절 기전을 밝힘으로서 위장질환의 원인균인 H. pylori를 퇴치하기 위한 기본바탕을 마련하고자 수행되었다. 우선적으로 metronidazole 내성을 조절하는 유전자인 fdxA(ferredoxin)에 의한 metronidazole 내성 조절 기전을 밝히기 위하여 다음의 연구를 수행하였다. Type I 균주인 26695균주의 fdxA 유전자에 chloramphenicol 내성 유전자를 삽입하여 결손돌연변이주를 구축하였다. fdxA의 비활성화에 의한 rdxA 및 frxA 유전자의 발현을 알아보기 위하여 2-D electrophoresis와 MALDI-TOP-MS을 이용하여 fdxA 유전자의 비활성화에 의해 over-expressed protein과 under-expressed protein을 검색하였다. 본 실험의 결과로 type I 균주인 26695에서 fdxA 유전자를 비활성화시킨 결과 frxA 유전자의 발현양이 증가함을 northern으로 확인하였으며, 또한 fdxA유전자의 downstream에 위치한 유전자들이 H. pylori의 생존에 중요한 역할은 한다는 것을 알 수 있었다. 또한 2-D electrophoresis와 MALDI-TOP-MS을 이용하여 fdxA 유전자의 inactivation에 의해 over-expressed protein으로 nifU-like protein(HP0221), frxA(HP0642), nonheme ferritin(HP0653)와 아직 기능이 밝혀지지 않은 hypothetical protein(HP0902) 등이 발견되었다. 그리고 5'-methylthioadenosine/S-adenosylhomocysteine nucleosidase(HP0089), (3R)-hydroxymyristoyl ACP dehydratase(HP1376)과 thioredoxin(HP1458)등이 under-expressed protein으로 발견되었다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권14호
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• pp.6089-6092
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• 2015

Background: The prevalence of metronidazole-resistant H. pylori is almost 50% in Thailand which severely limits the use of this drug for eradication therapy. The aims of this study were to evaluate the efficacy and safety profiles of 7-day bismuth-based quadruple therapy including metronidazole as an initial treatment for H. pylori infection in a high metronidazole resistance area. Materials and Methods: This study was performed at Thammasat University Hospital and King Chulalongkorn Memorial Hospital during January 2009 to October 2010. Patients with non-ulcer dyspepsia (NUD) with active H. pylori infection were assigned to receive seven days of quadruple therapy (pantoprazole 40 mg bid, bismuth subsalicylate 1,048 mg bid, amoxicillin 1 gm bid and metronidazole 400 mg tid). H. pylori infection was defined as positive H. pylori culture or two positive tests (rapid urease test and histology). Antibiotic susceptibility test for metronidazole by Epsilometer test (E-test) was performed in all positive cultures. At least four weeks after treatment, $^{13}C$ urea breath test ($^{13}C-UBT$) was performed to confirm H. pylori eradication. Results: A total of 114 patients were enrolled in this study, 50 males and 64 females with a mean age of 49.8 years. All 114 patients had a diagnosis of NUD. Overall eradication as confirmed by negative $^{13}C-UBT$ was achieved in 94 out of 114 patients (82.5%). 44 patients had positive cultures and success for E-test. In vitro metronidazole resistance was observed in 22/44 (50%) patients. Eradication rate in patients with metronidazole resistant strains was 16/22 (72.7%) and 20/22 (90.1%) with metronidazole sensitive strains (72.7% vs 90.1%, p-value=0.12; OR=3.75 [95%CI=0.6-31.5]). Minor adverse reactions included nausea, bitter taste, diarrhea and black stools but none of the patients dropped out from the study. Conclusions: Initial treatment with 7-day bismuth-based quadruple therapy including metronidazole, amoxycillin and pantoprazole is highly effective and well tolerated for metronidazole-sensitive H. pylori infections. However, the efficacy markedly decline with metronidazole resistance. Longer duration of this regimen might be required to improve the eradication rate and larger multi-center studies are needed to confirm this hypothesis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제14권1호
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• pp.45-51
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• 2011

목 적: Helicobacter pylori (H. pylori) 제균 치료의 적절한 항균제 선택의 기반이 되기 위해 소아에서 H. pylori 항균제 내성률을 알아보고자 하였다. 방 법: 2003년 7월부터 2009년 4월까지 상복부 통증으로 본원을 방문한 환자 중 위 문부 생검 조직 배양에서 H. pylori 가 동정된 균주를 대상으로 항균제 감수성 검사를 시행하였다. 감수성 검사는 clarithromycin과 amoxicillin은 디스크 확산법으로, tetracycline과 metronidazole은 E-test를 시행하였다. 치료 원칙은 감수성 결과가 확인 된 환자는 감수성 결과에 따라 항균제를 선택 하였고, BAM (bismuth subsalicylate, amoxicillin, metronidazole) 또는 OAC (omeprazole, amoxicillin, clarithromycin)를 바탕으로 한 경험적 삼제요법을 택하였다. 치료 실패 시에는 bismuth (또는 bismuth subsalicylate)를 포함한 사제요법을 선택하였다. 결 과: 33명의 환자가 배양검사 양성을 보였고 28명의 환자에서 감수성 검사를 시행하였다. 이 중 항균제 내성을 보인 환아는 9명(32.1%)으로 그 중 7명(25%)이 clarithromycin 내성 균주를 보였고 5명(17.8%)이 metronidazole 내성 균주를 보였다. 대상이 적어 통계적인 분석을 하지 못하였으나 Clarithromycin과 metronidazole의 내성률이 시기적으로 감소하는 추세를 보였다. 결 론: 본 연구는 단일 병원에서 소수의 환아를 대상으로 이루어진 연구로 한계가 있으나, 간접적으로 국내소아 환아에서 분리된 H. pylori의 균주에서도 높은 항균제 내성과 시기적으로 내성률이 변하는 것을 알 수있었다. 따라서 소아 환자에서 적절한 항균제 선택을 제시하기 위한 보다 광범위한 연구가 필요한 것으로 생각한다.

• Journal of Microbiology and Biotechnology
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• 제9권3호
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• pp.328-333
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• 1999

Susceptibility of 61 strains of Helicobacter pylori to metronidazole was examined by both the disk diffusion method using a cut-off of 15㎜ for resistance and the E test with a cut-off of 8㎎/l. The MIC/sub 50/ and MIC/sub 90/ by the E test were 2 ㎎/l and 256㎎/l, respectively. Metronidazole resistance was found in 22 (36％) out of the 61 H. pylori strains by the E test and in three additional strains by the disk diffusion method. Amongst the latter three isolates, the MICs by the E test were 4 ㎎/l, 6㎎/l, and 6㎎/l, respectively. These figures are one log₂ or half log₂ dilution lower than the cut-off of 8㎎/l recommended as resistance for the E test. All 22 metronidazole resistant H. pylori isolates by the E test that were subjected to random amplified polymorphic DNA (RAPD) fingerprinting showed different DNA fingerprints. Interestingly, >90％ of resistant isolates possess two common DNA bands of 0.4 and 0.9 kb. This study demonstrates that the results of the disk diffusion method for testing H. pylori susceptibility to metronidazole correlates well with that of the E test. The criteria for interpretation need to be internationally standardized so that the results from different centers can be compared.

• 대한미생물학회지
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• 제34권6호
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• pp.543-554
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• 1999

The purpose of this study was to evaluate the existence of amoxicillin, clarithromycin, and metronidazole resistance Helicobacter pylori and to determine the in-vitro MIC of two and three kinds of antibiotic concominant administration in the isolates. The antimicrobial agents tested against 169 H. pylori included metronidazole, amoxicillin, ciprofloxacin, clarithromycin, omeprazole, josamycin, erythromycin, and tetracycline. MIC of each antimicrobial agents was determined by broth microdilution method. The 169 strains of H. pylori were isolated from biopsy specimens of patients with gastric cancer. $MIC_{50}$ of clarithromycin, amoxicillin, metronidazole, omeprazole, erythromycin, josamycin, tetracycline, and ciprofloxacin was 2.0, 1.0, 4.0, 8.0, 0.5, 0.5, and $0.5\;{\mu}g/ml$, respectively. $MIC_{90}$ of clarithromycin, amoxicillin, metronidazole, omeprazole, erythromycin, josamycin, tetracycline, and ciprofloxacin was 64.0, 64.0, 32.0, 16.0, 8.0, 2.0, and $1.0\;{\mu}g/ml$, respectively. H. pylori isolates were detected in the following resistaince rates: 34.3% to clarithromycin, 31.9% to metronidazole, 20.7% to amoxicillin, 12.4% to erythromycin, and 10.1% to josamycin. The prevalence of the antibiotic resistant strains of H. pylori were detected 18.1% for two kind of antibiotics and 9.6% for three kind of antibiotics, and 3.9% for four kind of antibiotics. The $MIC_{90}$ of clarithromycin-, metronidazole-, and amoxicillin-resistant H. pylori was decreased under the $1\;{\mu}g/ml$ by the two or three kind of antibiotic concomitant administration in-vitro. These results suggest that two or three antibiotics concomitant administration could be more effective for the treatment of clarithromycin-, amoxicillin-, metronidazole-, and josamycin-resistant H. pylori strains.

• 대한상부위장관⦁헬리코박터학회지
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• 제18권4호
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• pp.242-246
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• 2018

Background/Aims: Helicobacter pylori eradication rates using first-line treatment have decreased due to clarithromycin resistance. The aim of this study was to investigate optimal eradication regimens for patients with clarithromycin resistance in Korea. Materials and Methods: A total of 72 patients with confirmed clarithromycin resistance were enrolled from August 2015 to July 2017. Patients were randomized to a 7-day bismuth quadruple therapy (BQT) regimen or a 7-day metronidazole triple therapy (MTT) regimen. Eradication was confirmed using the $^{13}C$-urea breath test. Results: There were no differences in baseline characteristics between the groups. Intention-to-treat eradication rates were 77.8% for the BQT group and 66.7% for the MTT group (P=0.293). Per protocol eradication rates were 87.5% for the BQT group and 77.4% for the MTT group (P=0.292). Adverse events were more frequent in the BQT group. Conclusions: Eradication rates using MTT were comparable to those using BQT, and adverse events were less frequent in the MTT group. Thus, MTT may be considered as a first-line regimen for patients with clarithromycin resistance. Since this was a pilot study, a study with a large group is required.

• Asian Pacific Journal of Cancer Prevention
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• 제16권10호
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• pp.4353-4356
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• 2015

Background: Levofloxacin is an effective medication for second line Helicobacter pylori (H. pylori) eradication. However, limited studies have approved its use as an effective antibiotic in first line therapy. Dexlansoprazole is a new PPI and lacks of evidence in support of a role in H. pylori eradication. This study was designed to evaluate efficacy of levofloxacin-dexlansoprazole-based quadruple therapy for H. pylori eradication in Thailand. Materials and Methods: This prospective randomized control study was performed during June 2014 to December 2014. H. pylori infected gastritis patients were randomized to receive 7- or 14-day levofloxacin-dexlansoprazole based on quadruple therapy (levofloxacin 500 mg OD, dexlansoprazole 60 mg bid, clarithromycin MR 1000 mg OD, bismuth subsalicylate 1048 mg bid). CYP2C19 genotyping and antibiotic susceptibility tests were conducted for all patients. A 13C urea breath test was performed to confirm H. pylori eradication at least 4 weeks after treatment. Results: A total of 100 patients were enrolled, comprising 44 males and 56 females (mean age of 52.6 years). Eradication rate by PP analysis was 85.7% (42/49) with the 7-day regimen and 98% (48/49) with the 14-day regimen (85.7% vs 98%; p-value=0.059). ITT analysis was 84% and 96% with 7- and 14-day regimens, respectively (84% vs 96%; p-value=0.092). Antibiotic susceptibility testing demonstrated 35.1% resistance to metronidazole, 18.3% to clarithromycin, and 13.5% to levofloxacin. CYP2C19 genotyping revealed 54.1% RM, 34.7% IM and 11.2% PM. The 14-day regimen provided 100% eradication in patients with clarithromycin or dual clarithromycin and metronidazole H. pylori resistant strains. Moreover, the eradication rate was 96.6% in patients with CYP2C19 genotype RM. Conclusions: The 14-day levofloxacin-dexlansoprazole based quadruple therapy provides high H. pylori eradication regardless of CYP2C19 genotype, clarithromycin or dual clarithromycin and metronidazole resistant strains. This regimen could be use as an alternative first line therapy for H. pylori eradication in Thailand.