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Updated: Jul 10, 2025
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 Chinese children: A multicenter study from 2016 to 2023
Wenyan Xu1, Bite Yang2, Lang Lin3
1Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China.
Insights
Antibiotic resistance in Helicobacter pylori (H. pylori) is high in Chinese children, particularly to clarithromycin and metronidazole, with increasing trends. Susceptibility remains high for amoxicillin, furazolidone, and tetracycline.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial resistance surveillance
- Gastroenterology
Background:
- Helicobacter pylori (H. pylori) infection is a global health concern, especially in pediatric populations.
- Antibiotic resistance significantly impacts treatment efficacy for H. pylori infections.
- Understanding regional and temporal trends in H. pylori antibiotic resistance is crucial for effective management.
Purpose of the Study:
- To determine the antibiotic resistance patterns of H. pylori strains in Chinese children.
- To assess resistance to clarithromycin, metronidazole, amoxicillin, levofloxacin, furazolidone, and tetracycline.
- To identify trends and regional variations in H. pylori antibiotic resistance over an 8-year period.
Main Methods:
- A multicenter, retrospective study involving 3074 H. pylori isolates from pediatric patients across China (2016-2023).
- Gastric mucosa biopsies were collected during upper gastrointestinal endoscopy.
- Antibiotic susceptibility testing was performed using the agar dilution method.
Main Results:
- High resistance rates were observed for clarithromycin (36.7%) and metronidazole (77.3%).
- Levofloxacin resistance was 16.6%, while amoxicillin, furazolidone, and tetracycline showed very low resistance (<0.3%).
- Resistance to clarithromycin and metronidazole significantly increased over time, with notable regional variations. Multi-drug resistance was found in 36.3% of isolates.
Conclusions:
- H. pylori resistance to clarithromycin and metronidazole is a significant and growing problem in Chinese children.
- Levofloxacin resistance is also a concern, whereas amoxicillin, furazolidone, and tetracycline remain effective.
- Continuous monitoring of H. pylori antibiotic resistance patterns in pediatric populations is essential for guiding clinical practice.
Background:
To investigate the antibiotic resistance of Helicobacter pylori (H. pylori) strains to clarithromycin, metronidazole, amoxicillin, levofloxacin, furazolidone, and tetracycline in Chinese children.
Materials And Methods:
This multicenter, retrospective study was conducted from January 2016 through May 2023. Gastric mucosa biopsies were obtained from pediatric participants who underwent upper gastrointestinal endoscopy at 96 hospitals in northern, southwestern, and southeastern China. The susceptibility of H. pylori to six commonly used antibiotics was determined by agar dilution method.
Results:
Among the 3074 H. pylori isolates, 36.7% were resistant to clarithromycin, 77.3% to metronidazole, 16.6% to levofloxacin, and 0.3% to amoxicillin. No strains were detected to be resistant to furazolidone or tetracycline. During the 8-year study period, resistance to clarithromycin and metronidazole showed a significant upward trend, while the resistance pattern of the other antibiotics demonstrated a slight but nonsignificant fluctuation. Significant regional differences were found in the distribution of clarithromycin resistance among the northern (66.0%), southwestern (48.2%), and southeastern (34.6%) regions. The metronidazole resistance rate was significantly lower in the southeastern coastal region (76.3%) than in the other two regions (88.2% in the north and 87.7% in the southwest). Multi-drug resistance for two or more antibiotics was detected in 36.3% of the H. pylori strains, and the predominant multi-resistance pattern was the dual resistance to clarithromycin and metronidazole.
Conclusions:
The prevalence of H. pylori resistance to clarithromycin and metronidazole is rather high in Chinese children and has been increasing over time. A relatively high resistance rate to levofloxacin was also noticed in children, while almost all strains were susceptible to amoxicillin, furazolidone, and tetracycline. It will be of great clinical significance to continuously monitor the antibiotic-resistance patterns of H. pylori in the pediatric population.
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