Is Helicobacter pylori antibiotic resistance surveillance needed and how can it be delivered

Alimentary Pharmacology and Therapeutics, 04/26/2012

Helicobacter pylori infection is now uncommon in dyspeptic patients at endoscopy. A surveillance system is feasible and necessary to inform dyspepsia management guidance. Clinicians should take a thorough antibiotic history before prescribing metronidazole, clarithromycin or levofloxacin for H. pylori.


  • The authors tested the antibiotic susceptibility of H. pylori isolates from biopsy specimens from 2063 of 7791 (26%) patients attending for endoscopy in Gloucester and Bangor, and 339 biopsy specimens sent to the Helicobacter Reference Unit (HRU) in London.
  • Culture and susceptibility testing was undertaken in line with National and European methods.


  • Helicobacter pylori were cultured in 6.4% of 2063 patients attending Gloucester and Bangor hospitals.
  • Resistance to amoxicillin, tetracycline and rifampicin/rifabutin was below 3% at all centres.
  • Clarithromycin, metronidazole and quinolone resistance was significantly higher in HRU (68%, 88%, 17%) and Bangor isolates (18%, 43%, 13%) than Gloucester (3%, 22%, 1%).
  • Each previous course of these antibiotics is associated with an increase in the risk of antibiotic resistance to that agent [clarithromycin: RR = 1.5 (P = 0.12); metronidazole RR = 1.6 (P = 0.002); quinolone RR = 1.8 (P = 0.01)].

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