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Updated: Nov 25, 2025
Gastric Mucosa Quantitative Polymerase Chain Reaction Analysis for Detecting Helicobacter pylori and Antibiotic Resistance
Published on: March 7, 2025
[Antibiotic resistances and eradication rates in Helicobacter pylori infection]
Gonzalo Botija1, Clara García Rodríguez1, Aránzazu Recio Linares1
1Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
Insights
Antibiotic resistance in Helicobacter pylori is high in children, impacting treatment success. Personalized therapy based on sensitivity testing and updated guidelines significantly improves eradication rates.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Gastroenterology
Context:
- Antibiotic resistance in Helicobacter pylori (H. pylori) poses a significant challenge to current treatment regimens.
- Understanding resistance patterns in pediatric populations is crucial for effective H. pylori eradication therapy.
Purpose:
- To describe the antibiotic resistance patterns of H. pylori in children.
- To evaluate the impact of updated treatment guidelines on eradication rates in pediatric H. pylori infections.
Summary:
- This retrospective study analyzed 80 children (ages 5-17) with H. pylori infections.
- High resistance rates were observed: clarithromycin (44.9%), metronidazole (16.3%), levofloxacin (7.9%), and amoxicillin (2%). Over two-thirds of patients exhibited resistance to at least one antibiotic.
- Treatment following the 2017 ESPGHAN guidelines resulted in significantly higher eradication rates (80%) compared to previous guidelines (55.8%).
Impact:
- Highlights the critical need for antibiotic sensitivity testing in pediatric H. pylori treatment.
- Emphasizes the improved efficacy of H. pylori eradication using updated treatment guidelines tailored to regional resistance patterns.
- Informs clinical practice and public health strategies for managing H. pylori infections in children.
Introduction:
The resistance to antibiotics of Helicobacter pylori (H. pylori) is the main factor that affects current therapeutic treatments. The main objective of this study is to describe the pattern of antibiotic resistances in children with an infection due to H. pylori.
Patients And Methods:
An observational, retrospective study was conducted from 2014 to 2019, which included patients between 5 and 17 years old, on whom a gastroscopy, with a gastric biopsy culture positive for H. pylori, and an antibiotic sensitivity study was performed. The antibiotic sensitivity studies were performed using an epsilometer (E-test). The cut-off points to define the resistances were those proposed by the European Committee on Antimicrobial Susceptibility Testing - EUCAST. The eradication study was performed using the 13C-urea breath test or the H. pylori monoclonal test in faeces 6-8 weeks after finalising the treatment.
Results:
The study included 80 patients (63.8% females), with a mean age of 11.9 years (SD±2.7DS). Over one-third (38.8%) of the patients had received previous treatment for H. pylori. In the endoscopy, peptic ulcer lesions were observed in 10% of patients. More than two-thirds (67.5%) had resistance to at least one drug. 16.3% presented double resistance. The primary resistances were: clarithromycin, 44.9%, metronidazole 16.3%, levofloxacine 7.9%, and amoxicillin 2%. Patients that received treatment according to the new ESPGHAN 2017 guidelines had significantly higher eradication rates compared to those that received treatment according to previous guidelines (80% vs. 55.8%, P=.04).
Conclusions:
The high rate of H.pylori resistances, and as a result, the low eradication rates, are still a very important cause for concern. The first line treatment, when this is indicated must be given following the antibiotic sensitivity studies, and in the cases where these cannot be done or are not available, at least in accordance with the regional resistance rates. The correct application of the new guidelines significantly improves the eradication rate.
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