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Eradication therapy for Helicobacter pylori infection based on the antimicrobial susceptibility test in children: A
Eri Miyata1, Takahiro Kudo1, Tamaki Ikuse1
1Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
Insights
Antimicrobial susceptibility testing significantly improves Helicobacter pylori eradication rates in children. This approach is crucial for effective treatment of H. pylori infection, especially with rising clarithromycin resistance.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Helicobacter pylori infection is a major cause of pediatric gastritis, ulcers, and gastric cancer.
- Childhood H. pylori infections require effective treatment strategies.
- Esophagogastroduodenoscopy (EGD) is vital for diagnosing H. pylori in children via biopsy and culture.
Purpose of the Study:
- To evaluate antimicrobial susceptibility testing and eradication rates in H. pylori-positive children.
- To assess the impact of rising clarithromycin resistance on treatment outcomes.
- To determine the effectiveness of tailored antibiotic regimens based on susceptibility testing.
Main Methods:
- Retrospective analysis of 45 H. pylori-positive pediatric patients undergoing EGD (2007-2018).
- H. pylori confirmation using serology, stool antigen, urea breath tests, and gastric biopsy culture.
- Triple therapy for 14 days, with eradication assessed at 2, 6, and 12 months post-treatment.
Main Results:
- Overall clarithromycin resistance was 71.1%, increasing significantly from 52.6% (2007-2012) to 84.6% (2013-2018).
- Tailored antibiotic selection based on susceptibility testing achieved a 97.7% primary eradication rate.
- Effective antibiotic prescribing significantly improved eradication success.
Conclusions:
- Antimicrobial susceptibility testing is essential for optimizing H. pylori eradication in children.
- Clinicians should consider susceptibility testing due to high and increasing clarithromycin resistance rates.
- Personalized antibiotic therapy based on resistance patterns enhances treatment efficacy.
Background:
Helicobacter pylori (H. pylori) infection causes chronic gastritis, duodenal and to a lesser extent, gastric ulcers, and gastric cancer. Most H. pylori infections are acquired in childhood, and effective treatment of childhood infection is very important. Esophagogastroduodenoscopy (EGD) is useful for endoscopic diagnosis, mucosal tissue biopsy, and culture examination for H. pylori in children and adults. In this paper, we report results of susceptibility tests and eradication rates in H. pylori-positive children who underwent EGD over a 12-year period.
Materials And Methods:
The subjects were H. pylori-positive pediatric patients who had gastrointestinal symptoms and underwent EGD in the Department of Pediatrics, Juntendo University Hospital (January 2007-December 2018). Patients underwent serum IgG antibody tests, fecal antigen tests, or urea breath tests, and subsequently, culture tests by gastric mucosal biopsy during EGD. H. pylori positivity was defined as a positive result on both tests. Patients received triple therapy for 14 days using our regimen, and eradication was assessed at 2, 6, and 12 months after therapy.
Results:
Forty-five patients were H. pylori-positive, and the overall clarithromycin (CAM) resistance rate was 71.1 % (32/45). The CAM resistance rate for the 2013-2018 period was significantly higher than the 2007-2012 period (52.6% vs. 84.6%, P < 0.05). According to the results of the antimicrobial susceptibility test, we prescribed effective antibiotics, and this resulted in a primary eradication rate of 97.7%.
Conclusions:
We suggest that antimicrobial susceptibility testing can significantly improve rates of primary eradication of H. pylori infection.
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