Is Helicobacter pylori antibiotic resistance surveillance needed and how can it be delivered
Alimentary Pharmacology and Therapeutics, 04/26/2012McNulty CAM et al.
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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