Antibiotic Resistance of Helicobacter pylori: Current Trends in Daegu-Kyungpook

Recent trends have shown reduced success rates of the standard triple therapy, underscoring the need for updated data on the antimicrobial resistance of Helicobacter pylori. This study aimed to assess the antibiotic resistance rates of H. pylori strains in the Daegu-Kyungpook region and compare them with other regions in South Korea to provide evidence for eradication therapy guidelines.

Between September 2022 and February 2024, samples from 100 patients aged 20-80 years with suspected H. pylori infections were collected across five medical institutions in the Daegu-Kyungpook region. The cultured strains were subjected to antimicrobial susceptibility testing. The minimum inhibitory concentrations for antibiotics were established using agar dilution methods, with breakpoints set at >0.125 μg/mL for amoxicillin, >0.25 μg/mL for clarithromycin, >1 μg/mL for tetracycline, >1 μg/mL for levofloxacin, and >8 μg/mL for metronidazole.

Among the 100 samples collected, cultures were performed for 98 samples, excluding 2 that tested negative in the rapid urease test or polymerase chain reaction. Of these, 73 (74%) samples were successfully cultured, while 25 (26%) failed. Among the 73 successful cultures, resistance was observed in 20 (27%) samples for amoxicillin, 25 (34%) for clarithromycin, 34 (47%) for metronidazole, 19 (26%) for tetracycline, and 27 (37%) for levofloxacin.

This study showed an overall increasing trend in antibiotic resistance rates, particularly in clarithromycin resistance, emphasizing the need to reconsider first-line triple therapy. This study is the first multicenter investigation of H. pylori antibiotic resistance in the Daegu-Kyungpook region, contributing valuable insights for developing region-specific treatment guidelines.