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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, Spain.
Insights
Antibiotic resistance in Helicobacter pylori (H. pylori) is a major challenge in treating children. This study found high resistance rates, particularly to clarithromycin, impacting treatment success.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Gastroenterology
Background:
- Antibiotic resistance in Helicobacter pylori (H. pylori) significantly compromises current treatment efficacy.
- Understanding resistance patterns in pediatric H. pylori infections is crucial for effective therapy.
Purpose of the Study:
- To delineate the spectrum of antibiotic resistance in pediatric H. pylori infections.
- To evaluate the impact of updated treatment guidelines on eradication rates in children.
Main Methods:
- Retrospective observational study (2014-2019) of 80 children (5-17 years) with H. pylori infection.
- Gastric biopsy cultures and antibiotic sensitivity testing using E-test (EUCAST criteria).
- Eradication assessed via 13C-urea breath test or fecal H. pylori antigen test.
Main Results:
- High prevalence of resistance: 67.5% resistant to at least one antibiotic; 16.3% had double resistance.
- Primary resistances observed: Clarithromycin (44.9%), Metronidazole (16.3%), Levofloxacin (7.9%), Amoxicillin (2%).
- Treatment following updated ESPGHAN 2017 guidelines yielded significantly higher eradication rates (80%) compared to previous guidelines (55.8%).
Conclusions:
- Elevated H. pylori resistance rates contribute to low eradication success in children.
- Antibiotic sensitivity testing or regional resistance data should guide first-line H. pylori treatment.
- Adherence to current guidelines substantially enhances pediatric H. pylori eradication rates.
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 ± 2.7 DS). 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 = 0.04).
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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