Is Helicobacter pylori antibiotic resistance surveillance needed and how can it be delivered?
Article first published online: 2 APR 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 35, Issue 10, pages 1221–1230, May 2012
How to Cite
McNulty, C. A. M., Lasseter, G., Shaw, I., Nichols, T., D'Arcy, S., Lawson, A. J. and Glocker, E. (2012), Is Helicobacter pylori antibiotic resistance surveillance needed and how can it be delivered?. Alimentary Pharmacology & Therapeutics, 35: 1221–1230. doi: 10.1111/j.1365-2036.2012.05083.x
- Issue published online: 15 APR 2012
- Article first published online: 2 APR 2012
- Manuscript Accepted: 10 MAR 2012
- Manuscript Revised: 8 MAR 2012
- Manuscript Revised: 29 DEC 2011
- Manuscript Received: 15 DEC 2011
- Health Protection Agency Pump Priming & Small Scientific Initiatives
Most patients are prescribed Helicobacter 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.
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.
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.
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)].
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.