Letters to the Editors
Letter: surveillance of Helicobacter pylori antibiotic resistance
Article first published online: 7 NOV 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 36, Issue 11-12, page 1102, December 2012
How to Cite
Porowska, B., Mascellino, M. T. and Severi, C. (2012), Letter: surveillance of Helicobacter pylori antibiotic resistance. Alimentary Pharmacology & Therapeutics, 36: 1102. doi: 10.1111/apt.12070
- Issue published online: 7 NOV 2012
- Article first published online: 7 NOV 2012
We read the article by McNulty et al. with great interest. The authors have issued very important data regarding Helicobacter pylori antibiotic resistance in patients attending for endoscopy in England and Wales. Culture and susceptibility testing based therapies seem to be the most logical step to overcome the problem of resistant strains, but, as described by the authors, culture can turn out to be negative, even in the presence of a positive urease test.
Chronic PPI intake is considered to be the main cause of culture failure and when considering options for susceptibility testing, biopsy specimens should also be taken from the gastric body. In our experience, biopsy specimens for susceptibility testing should always include investigation of all three gastric regions especially in patients who had already received more than two therapeutic eradication schedules.
We have investigated a group of patients affected with pangastritis and positive urea breath test, who had more than two previous eradication schedules. In these patients, we took three samples each from the antrum and corpus and another two from the fundus. This method should theoretically be very accurate, and hence, we expected the successful culture rate to be high. However, only 62% (31 out of 50) of our patients had a positive culture, and only one-third of them could be eradicated on the basis of susceptibility testing.
In the positive culture group, we found very high resistance rates to all antibiotics (metronidazole 97%, levofloxacin 58%, clarithromycin 55%, amoxicillin 29% and tetracycline 23%). The policy to investigate all gastric regions is also important in revealing eventual presence of hetero-resistance. Partial data of our study have been published in abstract form.
We fully concord with the authors when they state that clinicians should question their patients about the antibiotics used in their lifetime before selecting eradication therapies.
Declaration of personal and funding interests: None.
- 3The challenge of Helicobacter pylori eradication therapies based on antibiotic susceptibility testing in a highly selected group of pangastritis patients. Gut 2011; 60(Suppl. 3): A384., , , .