Kato S, Fujimura S
Primary Antimicrobial Resistance of Helicobacter pylori in Children during the Past 9 Years. [JOURNAL ARTICLE]
Pediatr Int 2009 Jun 26.
Background: Antimicrobial resistance of Helicobacter pylori is a growing problem in clinical practices, particularly clarithromycin resistance. We aimed to study the prevalence of H. pylori resistance to antimicrobial agents in Japanese children.
Methods: A total of 61 H. pylori strains isolated from children (mean age, 12.6 years; range, 4-18 years) between 1999 and 2007 were studied for primary antimicrobial resistance, using a microdilution method. In addition, the eradication rate with lansoprazole-based triple regimens was determined.
Results: The overall resistance rate of clarithromycin, amoxicillin and metronidazole was 36.1%, 0% and 14.8%, respectively. Resistance to both clarithromycin and metronidazole was detected in 6.6% of the strains. The rate of clarithromycin-resistant strains was 32.4% from 1999-2002 and 40.7% from 2003-2007, and clarithromycin MIC(90) value showed a 4-fold increase from1999-2002 to 2003-2007, with all clarithromycin-resistant strains showing low-level resistance. Metronidazole resistance rates were not different between these two study periods. Regimens with amoxicillin and clarithromycin (n = 49) showed a higher eradication rate in clarithromycin-susceptible strains (97.1%) than in the resistant strains (57.1%) (p < 0.001). There was no difference in the eradication rate between 7-day and 10- or 14-day courses of the regimens (p= 0.53). The regimen with amoxicillin and metronidazole produced successful eradication in all 9 patients with clarithromycin- resistant strains.
Conclusions: These data show that clarithromycin resistance of H. pylori retains a high prevalence, and that triple regimen treatment containing clarithromycin should be decided based on susceptibility to the agent.
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