Korean J Gastroenterol.  2007 Dec;50(6):356-362.

Changing Patterns of Antibiotic Resistance of Helicobacter pylori in Patients with Peptic Ulcer Disease

• Bang SY
• Han DS
• Eun CS
• Kim JE
• Ahn SB
• Sohn JH
• Jeon YC
• Kang JO

Abstract

BACKGROUND/AIMS: Antibiotic resistance of Helicobacter pylori (H. pylori) is a significant clinical problem because it reduces the efficacy of eradication therapy. The aims of this study were to assess the changing patterns of antibiotic resistance of H. pylori in patients with peptic ulcer diseases and to evaluate the eradication rate in antibiotic resistant H. pylori strains. METHODS: One hundred forty four H. pylori isolates obtained from 466 patients with peptic ulcer disease between June 2001 and December 2005 were examined for antimicrobial resistance. The minimum inhibitory concentration (MIC) of metronidazole was determined by modified broth microdilution method (mBMD) and E test. MICs of clarithromycin and amoxicillin were determined by mBMD, E test, and disc diffusion test. The breakpoints for metronidazole, clarithromycin, and amoxicillin resistance were defined as >8microgram/mL, >1microgram/mL, and > or =1microgram/mL, respectively. RESULTS: Resistance to metronidazole and clarithromycin was detected in 34.7% and 16.7% of H. pylori isolates, respectively. During the recent 5-year study period, amoxicillin-resistant rate of H. pylori was 11.8%, and multi-drug resistance rate of H. pylori was 16.7%. The eradication rate of clarithromycin containing triple therapies was low (7.8%) in clarithromycin-resistant H. pylori strains. CONCLUSIONS: The proportions of clarithromycin-resistant H. pylori strains have increased significantly over the last 5-years. There is an increasing tendency for the emergence of strains with multi-drug resistance. The increase in clarithromycin-resistant strains results in a decrease in eradication rate for H. pylori. In areas with high clarithromycin resistance, new alternative first-line treatment combination should be considered.

Keyword

Helicobacter pylori; Antibiotic resistance

MeSH Terms

Adult
Aged
Amoxicillin/therapeutic use
Anti-Bacterial Agents/therapeutic use
Clarithromycin/adverse effects/therapeutic use
Disk Diffusion Antimicrobial Tests
*Drug Resistance, Bacterial
Drug Therapy, Combination
Female
Helicobacter Infections/*drug therapy/microbiology
Helicobacter pylori/*drug effects/isolation & purification
Humans
Male
Metronidazole/therapeutic use
Microbial Sensitivity Tests
Middle Aged
Peptic Ulcer/*drug therapy
Retrospective Studies