Antibiotic-resistance patterns of Helicobacter pylori in Croatia: cohort study

To provide information on regional sensitivity of H. pylori to antibiotic treatment by investigating the rate of H. pylori eradication in Croatia.

The study included 217 outpatients (107 women and 110 men), with gastrointestinal symptoms and H. pylori positive finding. They received the first-line and second-line treatments. The first-line treatment included triple therapies with either omeprazole (omeprazole, amoxicillin, and metronidazole - OAM), or pantoprazole (pantoprazole, amoxicillin, and metronidazole - PAM), or a combination of ranitidine bismuth citrate, amoxicillin, and azithromycin (RBAAz). If this therapy failed, clarithromycin was used in the second-line treatment.

H. pylori was eradicated in 93% of the patients, whereas in 7% it was resistant to all administered therapies. The efficacy of OAM or PAM first-line treatments in H. pylori eradication, including resistant patients, was 70%, and of RBAAz treatment 95%. The RBAAz treatment had the highest eradication rate. In the second-line treatment, clarithromycin eradicated 45% of the remaining H. pylori strains that had not reacted to metronidazole and azithromycin administered either alone or in combination with ranitidine bismuth citrate.

Optimal therapy for the eradication of H. pylori infection is the RBAAz treatment, whereas metronidazole cannot be recommended because of the high rate of resistance of H. pylori to that antibiotic.