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Is H elicobacter pylori antibiotic resistance surveillance needed and how can it be delivered?
Author(s) -
McNulty C. A. M.,
Lasseter G.,
Shaw I.,
Nichols T.,
D'Arcy S.,
Lawson A. J.,
Glocker E.
Publication year - 2012
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2012.05083.x
Subject(s) - clarithromycin , medicine , metronidazole , levofloxacin , helicobacter pylori , antibiotics , rifabutin , antibiotic resistance , amoxicillin , rifampicin , gastroenterology , ciprofloxacin , microbiology and biotechnology , pathology , tuberculosis , biology
Summary Background Most patients are prescribed H elicobacter pylori treatment without culture and antibiotic susceptibility testing, as current guidance recommends that patients with recurrent dyspepsia should be tested for H . pylori using a non‐invasive breath or faecal antigen test. Aims To determine the prevalence of H . pylori antibiotic resistance in patients attending endoscopy in England and Wales, and the feasibility of an antibiotic resistance surveillance programme testing. Methods We 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. Results H elicobacter 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)]. Conclusions H elicobacter 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 .