Related Experiment Video
Updated: Feb 6, 2026
Detection of Helicobacter pylori Infection and Antibiotic Resistance via Stool Quantitative Polymerase Chain Reaction Analysis
Published on: May 16, 2025
Helicobacter pylori antimicrobial resistance in a pediatric population
Gisela M Silva1, Helena Moreira Silva1, Joao Nascimento1
1Pediatric Gastroenterology Unit, Centro Materno-Infantil do Norte, Centro Hospitalar do Porto, Oporto, Portugal.
Insights
High clarithromycin resistance in Helicobacter pylori (H. pylori) infections impacts treatment success. Tailored antimicrobial susceptibility testing led to a high eradication rate in children.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Antimicrobial Resistance
Background:
- Increasing prevalence of Helicobacter pylori (H. pylori) antimicrobial resistance, particularly to clarithromycin, reduces treatment efficacy.
- Understanding local resistance patterns is crucial for effective H. pylori eradication strategies.
Purpose of the Study:
- To determine the local antimicrobial resistance patterns of H. pylori.
- To evaluate the eradication rate of H. pylori infection in a pediatric population.
Main Methods:
- Prospective cohort study of H. pylori infected pediatric patients.
- Antimicrobial susceptibility testing using E-test for phenotypic resistance (amoxicillin, metronidazole, clarithromycin, levofloxacin).
- Genotypic resistance to clarithromycin was assessed; eradication confirmed by urea breath test or fecal antigen test.
Main Results:
- High clarithromycin resistance rates (23.3% phenotypic, 37.2% genotypic) were observed.
- No resistance to amoxicillin or levofloxacin was detected.
- An overall eradication rate of 97.8% was achieved, with tailored treatment regimens.
Conclusions:
- A high rate of H. pylori clarithromycin resistance in this pediatric center necessitates a change in first-line treatment guidelines.
- Clarithromycin should be reconsidered as a first-line H. pylori treatment in children.
- Personalized eradication treatment based on antimicrobial susceptibility testing may explain the high success rate.
Background:
The increasing prevalence of Helicobacter pylori (H. pylori) antimicrobial resistance, primarily for clarithromycin decreases the success of treatment. The aim of this study is to determine the local pattern of first-line antimicrobials resistance and the eradication rate.
Material And Methods:
Prospective cohort study of H. pylori infected patients (positive histological or cultural exams) treated at Centro Materno-Infantil do Norte from January of 2013 to October of 2017. Susceptibility to 4 antibiotics: amoxicilin, metronidazole, clarithromycin, and levofloxacin were analyzed by E-test (phenotypic resistance). The E-test was chosen because it is simple and cost-effective for routine susceptibility testing. Point mutations that confer clarithromycin resistance were surveyed (genotypic resistance). Eradication of H. pylori infection was defined by a negative urea breath test or fecal antigen 6-8 weeks after the end of treatment.
Results:
Of a total of 74 H. pylori infected patients, 16 were excluded because they had previous H. pylori treatment or severe systemic disease. Median age of infection cases was 15 years (3-17 years). Eradication regimen used in all patients combined the use of 3 antibiotics (amoxicillin and metronidazole or clarithromycin) and proton pump inibhitor for 14 days and was tailored according antimicrobial susceptibility. 79.5% of the patients completed the treatment. The resistance rate for metronidazole and clarithromycin was 3.3% and 23.3%, respectively. There was no resistance for amoxicilin and levofloxacin. The rate of genotypic resistance to clarithromycin was 37.2%. The eradication rate was 97.8%.
Conclusions:
The authors found a high resistance rate of H. pylori for clarithromycin in this northern portuguese pediatric center. This factor should determine a change in local current treatment, contraindicating the use of clarithromycin as a first-line treatment for H. pylori infection in children. The high eradication rate maybe explained for the eradication treatment tailored according antimicrobial susceptibility.
Related Concept Videos
01:16Treating Helicobacter pylori in Peptic Ulcers: Antimicrobial Therapy
02:04Conservation of Small Populations
01:28Antimicrobial Effectiveness
01:25What is Population Genetics?
00:57Population Growth
01:23Antimicrobial Proteins
Interferons
Interferons (IFNs) are proteins produced by lymphocytes, macrophages, and fibroblasts infected with viruses. While IFNs cannot prevent viruses from entering and...