Sensitivity of Helicobacter pylori to metronidazole

Gastric antral forceps biopsies taken at gastroscopy were cultured for Helicobacter pylori and tested for anti-microbial sensitivity. Using micro-aerophilic culture, and disc testing or E-testing, there was 98-100% sensitivity to amoxycillin, tetracycline, clarithromycin and erythromycin. However, there was apparent resistance to metronidazole in 19 of 102 samples (19%). When sensitivity by E-testing was performed with preliminary anaerobic culture for 24 h only two of 94 samples (2%) showed resistance. In 37 cultures both micro-aerophilic disc testing and anaerobic then micro-aerophilic E-testing were conducted. Eight cultures showed resistance upon disc testing (MIC > 5 mg/l) but all of these organisms were sensitive on E-testing (MIC 0.003-0.5 mg/l). Metronidazole may be used with confidence in eradication regimes.