Peningkatan Resistensi Antibiotik Clarithromycin dan Metronidazole terhadap Helicobacter pylori dan Tinjauan Implikasinya terhadap Terapi Peptic Ulcer Disease

Salsabila Salsabila; Ni Putu Widiadnyani Putri; Keisha Andini Sakina; Riesky Maulani; Mufida Lisya Fatiha; Tuhfatul Ulya

doi:10.31004/koloni.v5i3.1257

Authors

Salsabila Salsabila Universitas Mataram
Ni Putu Widiadnyani Putri Universitas Mataram
Keisha Andini Sakina Universitas Mataram
Riesky Maulani Universitas Mataram
Mufida Lisya Fatiha Universitas Mataram
Tuhfatul Ulya Universitas Mataram

DOI:

https://doi.org/10.31004/koloni.v5i3.1257

Keywords:

Resistensi Helicobacter pylori; Resistensi klaritromisin; Resistensi metronidazole; Kegagalan eradikasi; Terapi ulkus peptikum

Abstract

Peptic Ulcer Disease (PUD) remains a significant global health problem, with a substantial proportion of cases associated with Helicobacter pylori infection. The success of eradication therapy depends largely on antibiotic effectiveness, particularly that of clarithromycin and metronidazole. However, increasing H. pylori resistance to these antibiotics has become a major challenge, leading to treatment failure and reduced eradication rates. This review aims to examine current H. pylori resistance patterns to clarithromycin and metronidazole and their implications for eradication therapy. Evidence from various studies indicates that clarithromycin resistance reduces the efficacy of standard triple therapy consisting of a proton pump inhibitor (PPI), clarithromycin, and either amoxicillin or metronidazole. Metronidazole resistance also contributes to eradication failure, although its impact may be partially overcome by adjusting the dose or extending treatment duration. Therefore, therapeutic regimens should be selected based on local resistance patterns and rational antibiotic use. Alternative regimens, such as bismuth-based quadruple therapy, may be considered in regions with high resistance rates. Continuous surveillance of H. pylori antibiotic resistance is essential to improve eradication success and clinical outcomes in patients with PUD.

References

Alba, C., Blanco, A., & Alarco, T. (2017). Antibiotic resistance in Helicobacter pylori. https://doi.org/10.1097/QCO.0000000000000396

Atepela, J. H. (2023). Proton Pump Inhibitor (PPI) sebagai Farmakoterapi GERD pada Lansia. Cermin Dunia Kedokteran, 50(7), 379-382. https://doi.org/10.55175/cdk.v50i7.635

Atharini, Y. H., Probosuseno, P., & Nugroho, A. E. (2016). Pola Pengobatan dan Luaran Klinis Pada Pasien Terinfeksi Helicobacter Pylori. Jurnal Manajmen dan Pelayanan Farmasi (Journal of Management and Pharmacy Practice), 6(2), 151-158. https://doi.org/10.22146/jmpf.267

Biernat, M. M., Bińkowska, A., Łaczmański, Ł., Biernat, P., Krzyżek, P., & Gościniak, G. (2020). Phenotypic and Genotypic Analysis of Resistant Helicobacter pylori Strains Isolated from Children with Gastrointestinal Diseases. Diagnostics, 10(10), 759. https://doi.org/10.3390/diagnostics10100759

Bricker-ford, R. (2021). Novel “ High-dose Quad ” Salvage Therapy Approach for Helicobacter pylori Infection : A Case Report. 1–5. https://doi.org/10.1177/08971900211033143

Bujanda, L., Nyssen, O. P., Ramos, J., Bordin, D. S., Tepes, B., Perez-Aisa, A., Pavoni, M., Castro-Fernandez, M., Lerang, F., Leja, M., Rodrigo, L., Rokkas, T., Kupcinskas, J., Jonaitis, L., Shvets, O., Gasbarrini, A., Simsek, H., Phull, P. S., Buzás, G. M., Machado, J. C., … Hp-EuReg investigators (2024). Effectiveness of Helicobacter pylori Treatments According to Antibiotic Resistance. The American journal of gastroenterology, 119(4), 646–654. https://doi.org/10.14309/ajg.0000000000002600

Fauzia, K. A., Miftahussurur, M., Syam, A. F., Waskito, L. A., Doohan, D., Rezkitha, Y. A. A., & Yamaoka, Y. (2020). Biofilm formation and antibiotic resistance phenotype of Helicobacter pylori clinical isolates. Toxins, 12(8), 473. https://doi.org/10.3390/toxins12080473

Haddadi, M. H., Negahdari, B., Asadolahi, R., & Bazargani, A. (2020). Helicobacter pylori antibiotic resistance and correlation with cagA motifs and homB gene. Postgraduate medicine, 132(6), 512–520. https://doi.org/10.1080/00325481.2020.1753406

Lapina, T. L., & Ivashkin, V. T. (2023). Rebamipide during chronic gastritis: H. pylori eradication therapy and restoration of gastric mucosa barrier function. Russian Journal of Gastroenterology, Hepatology and Coloproctology, 33(6), 81–87. https://doi.org/10.22416/1382-4376-2023-33-6-81-87

Lukas, D. L., Cahjono, H., & Agung, P. P. (2025). Diagnosis Dan Tatalaksana Resistensi Antibiotik Helicobacter Pylori. https://dspace.uc.ac.id/handle/123456789/8247

Mentari, A., Kusumajaya, H., & Meilando, R. (2025). Faktor-faktor yang berhubungan dengan kekambuhan penyakit tukak lambung di UPTD Puskesmas Melintang Kota Pangkalpinang tahun 2024. Jurnal Kesehatan Tambusai, 6(1), 718–728.

Metwally, M., Ragab, R., Abdel Hamid, H. S., Emara, N., & Elkholy, H. (2022). Helicobacter pylori Antibiotic Resistance in Egypt: A Single-Center Study. Infection and Drug Resistance, 15, 5905–5913. https://doi.org/10.2147/IDR.S386082

Nyssen, O. P., Francis, M., Savarino, V., Fallone, C. A., Bazzoli, F., & Gisbert, J. P. (2024). Sequential versus Standard Triple Therapy for First-Line Helicobacter pylori Eradication : An Update. https://doi.org/10.3390/antibiotics13020136

Pertiwi, R., Wibowo, R. H., Notriawan, D., Nasution, R. P., & Azhar, A. W. (2024). Aktivitas Antibakteri Ekstrak Daun Mangrove (Rhizophora mucronata) pada Bakteri Helicobacter pylori Penyebab Tukak Lambung. Bioscientist: Jurnal Ilmiah Biologi, 12(1), 202-209. https://doi.org/10.33394/bioscientist.v12i1.9957

Rosu, O. M., Gimiga, N., Stefanescu, G., Ioniuc, I., Tataranu, E., Balan, G. G., Ion, L. M., Plesca, D. A., Schiopu, C. G., & Diaconescu, S. (2022). The Effectiveness of Different Eradication Schemes for Pediatric Helicobacter pylori Infection-A Single-Center Comparative Study from Romania. Children (Basel, Switzerland), 9(9), 1391. https://doi.org/10.3390/children9091391

Suwarni, S. (2023). Helicobacter pylori: Manifestasi Ekstragastrik pada Dysmenorrhea Primer. Uwais Inspirasi Indonesia.

Soviarni, S., & Sarniyati, S. (2022). Edukasi Pencegahan Dan Penanganan Gastritis Pada Masyarakat Diwilayah Kerja Puskesmas Depati VII. Jurnal Pengabdian Masyarakat Bina Insani Sakti, 1(1, Oktober), 68-74.

Waheed, N., Nighat, H., Muqaddar, S., Rehmana, W., Maryam Naseer, Ayesha Razzaq, J. K. (2023). Primary antibiotic resistance and effectiveness of clarithromycin vs metronidazole based therapy for helicobacter pylori infection in children,. 35(3), 390–393. https://doi.org/10.55519/JAMC-03-11648

Zhang, Y., Wen, Y., Xiao, Q., Zheng, W., Long, G., Chen, B., Shu, X., & Jiang, M. (2020). Mutations in the Antibiotic Target Genes Related to Clarithromycin , Metronidazole and Levo fl oxacin Resistance in Helicobacter pylori Strains from Children in China. 311–322.

Zhang, Y., Meng, F., Jin, J., Wang, J., Gu, B., Peng, J., & Ye, L. (2021). Ninety-four thousand-case retrospective study on antibacterial drug resistance of Helicobacter pylori Yu. 9(35), 10838–10850. https://doi.org/10.12998/wjcc.v9.i35.10838