Esophagus to Small Intestine

Am J Gastroenterol. 2023;118(2):269–75

Mégraud F, Graham DY, Howden CW, Trevino E, Weissfeld A, Hunt B, Smith N, Leifke E, Chey WD

Rates of antimicrobial resistance in Helicobacter pylori isolates from clinical trial patients across the US and Europe

Introduction: Guidelines recommend that proton-pump inhibitor-based triple regimens with clarithromycin not be used for Helicobacter pylori infection in areas where clarithromycin resistance is ≥ 15%, or in patients with prior macrolide use. Up-to-date information on local resistance patterns is limited, especially in the US. Here, the authors report resistance rates to antibiotics commonly used to treat H. pylori from a large study conducted in the US and Europe (pHalcon-HP).
Methods: Gastric mucosal biopsies were collected from adult participants with H. pylori infection during screening. Minimum inhibitory concentrations were determined via agar dilution for clarithromycin, amoxicillin, and metronidazole, with breakpoints ≥ 1 μg/ml, > 0.125 μg/ml, and > 8 μg/ml, respectively. Resistance rates were obtained for the US and Europe, and also for US subregions and participating European countries.
Results: Resistance rates were established in isolates from 907 participants. Overall, 22.2% were resistant to clarithromycin, 1.2% to amoxicillin, and 69.2% to metronidazole. Resistance in the US and Europe was similar; metronidazole resistance was the most prevalent (50–79%) and amoxicillin the least (≤ 5%). In all subregions, ≥ 15% of isolates were resistant to clarithromycin, except the UK (0/8 isolates). Among clarithromycin-resistant isolates, 75% were also metronidazole-resistant. Two US isolates were resistant to clarithromycin and amoxicillin; 1 of these was also metronidazole-resistant.

Discussion: The resistance rates observed in this study argue against the continued empiric use of proton-pump inhibitor-based triple therapy containing clarithromycin, per treatment guidelines, and highlight the need for antibiotic resistance surveillance and novel treatment strategies for Helicobacter pylori infection in the US and Europe.

Prof. Dr. F. Mégraud, UMR BRIC, INSERM U1312, University of Bordeaux, Bordeaux, France,

DOI: DOI: 10.14309/ajg.0000000000002045

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