Primary resistance in Helicobacter pylori isolated in children from Iran

Area of Science:

• Pediatric Infectious Diseases
• Microbiology
• Gastroenterology

Background:

• Helicobacter pylori infection is prevalent in Iran, yet antimicrobial susceptibility data for pediatric eradication regimens are scarce.
• Understanding local resistance patterns is crucial for effective H. pylori treatment strategies in children.

Purpose of the Study:

• To determine the antimicrobial resistance rates of H. pylori strains isolated from Iranian children.
• To evaluate susceptibility to six key antimicrobials used in H. pylori eradication.
• To recommend an updated, effective anti-H. pylori treatment regimen for pediatric patients in Iran.

Main Methods:

• Prospective collection of 100 H. pylori strains from children undergoing gastroscopy (2003-2005).
• Antimicrobial susceptibility testing using E test and disk diffusion methods for six agents.
• Collection of demographic data and clinical presentation, including abdominal pain.

Main Results:

• Extremely high resistance rates observed: 95% to metronidazole, 59% to amoxicillin.
• Moderate resistance to clarithromycin (16%), low resistance to furazolidone (9%), ciprofloxacin (7%), and tetracycline (5%).
• No significant differences in resistance based on age, sex, or clinical presentation.

Conclusions:

• Iranian children exhibit very high H. pylori resistance to metronidazole and amoxicillin, necessitating treatment regimen revision.
• Clarithromycin resistance is moderate, while ciprofloxacin and tetracycline show low resistance.
• Updated treatment guidelines incorporating current susceptibility data are essential for successful H. pylori eradication in pediatric populations.