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Updated: Jun 15, 2026
Gastric Mucosa Quantitative Polymerase Chain Reaction Analysis for Detecting Helicobacter pylori and Antibiotic Resistance
Published on: March 7, 2025
Antibiotic resistance of Helicobacter pylori in Israeli children
Noam Zevit1, Itzhak Levy, Haim Shmuely
1Department of Nutrition and Liver Diseases, Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel. nzevit@gmail.com
Insights
Antibiotic resistance in Helicobacter pylori is high in Israeli children, especially after prior treatment. Culture-based therapy is recommended for previously treated patients to address clarithromycin and metronidazole resistance.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Antimicrobial Resistance
Background:
- Helicobacter pylori infection is a significant global health concern, particularly in pediatric populations.
- Antibiotic resistance in H. pylori complicates treatment regimens and necessitates ongoing surveillance.
Purpose of the Study:
- To determine antibiotic susceptibility patterns of H. pylori in Israeli children.
- To assess the impact of prior antibiotic exposure on H. pylori resistance.
- To investigate the presence of multiple H. pylori strains with varying resistance profiles in individual patients.
Main Methods:
- A prospective case-series study involving 174 children (aged 1-18 years) undergoing gastroscopy.
- Antibiotic susceptibility testing (amoxicillin, clarithromycin, metronidazole, tetracycline, levofloxacin) performed using E-test on gastric biopsies.
- Data collection via questionnaires on clinical and demographic information, including previous antibiotic use.
Main Results:
- High primary resistance rates observed: 25% to clarithromycin and 19% to metronidazole in treatment-naïve children.
- Significantly higher resistance rates in previously treated children: 42% for clarithromycin and 52% for metronidazole.
- No resistance detected against amoxicillin, tetracycline, or levofloxacin.
- Clarithromycin resistance correlated with prior macrolide use (p=0.033).
- Simultaneous colonization by distinct H. pylori strains occurred in 3.8% of patients.
Conclusions:
- Elevated rates of H. pylori resistance to clarithromycin and metronidazole are prevalent in Israeli pediatric populations.
- Previous H. pylori treatment is a significant risk factor for developing resistance.
- Culture-based treatment strategies are advisable for previously treated children to guide effective therapy.
- The clinical significance of simultaneous colonization by multiple H. pylori strains warrants further investigation.
Objectives:
To determine the antibiotic susceptibility of Helicobacter pylori isolates from Israeli children; assess the role of previous antibiotic use in the development of antibiotic resistance and examine the possibility of simultaneous colonization of strains with different resistance patterns in the same patients.
Material And Methods:
A prospective case-series design was used. The study group included 174 patients aged 1-18 years referred to the Schneider Children's Medical Center of Israel for gastroscopy over a 2.5-year period. Antibiotic susceptibility to amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin was determined by E-test on gastric biopsies (2 per patient). Clinical and demographic data were obtained by questionnaire.
Results:
Cultures for H. pylori yielded 55 isolates from 53 children. In treatment-naïve children, the prevalence rate of primary resistance to clarithromycin was 25% and to metronidazole, 19%. Respective rates in children previously treated for H. pylori infection were 42% (p = 0.22) and 52% (p = 0.016). Simultaneous resistance to both drugs was found in 13% of isolates (n = 7), all from children with previous treatment failure. No resistance was found to amoxicillin, tetracycline or levofloxacin. Clarithromycin resistance was associated with macrolide use for any indication during the previous year (p = 0.033). In 2 patients (3.8%), a different H. pylori strain was cultured from each biopsy.
Conclusions:
H. pylori resistance to clarithromycin and metronidazole is high in Israeli children, particularly in those previously treated for H. pylori infection, in whom culture-based treatment should be considered. The simultaneous colonization of multiple strains in a minority of patients needs to be further characterized.
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