Z Gastroenterol 2004; 42 - 73
DOI: 10.1055/s-2004-826974

Genotypic clarithromycin resistance of helicobacter pylori in relation to eradication therapy

I Kovács 1, A Tiszai 1, Z F. Kiss 2, F Sükösd 3, L Tiszlavicz 3, I Nagy 1, J Lonovics 1
  • 11st Dept. of Medicine, Univ. of Szeged
  • 2Polyclinic, Szeged
  • 3Dept. of Pathology, Univ. of Szeged

The resistance of Helicobacter pylori to antimicrobial agents, and particularly to metronidazole and clarithromycin (CLA), is an important factor affecting the outcome of standard treatments for H. pylori eradication.

Aim: To study the occurrence of CLA-R of in H. pylori-infected patients in relation to previous eradication therapy.

Patients: 190 H. pylori-infected adults suffering from peptic ulcer disease, erosive gastroduodenitis or nonulcer dyspepsia. Of them, 55 had received previous eradication therapy with a CLA-based regimen. Samples from a group of 135 pts who had never been given CLA-based eradication therapy served as control.

Methods: Genotypic CLA-R was investigated histologically by a fluorescent in situ hibridization (FISH) method used on gastric biopsy specimens.

Results: In the control group, only 12 of the 135 pts (8.9%) were found to have H. pylori strains resistant to CLA. The prevalence of CLA-resistant H. pylori strains in those with previous eradication therapy was as high as 43.6% (24 of the 55); this difference between the two groups was statistically significant (P<0.001).

Conclusions: These data demonstrate that the resistance of H. pylori to CLA is strongly associated with the earlier use of this macrolid antibiotic as a component of therapeutic combinations aimed at eradication of this infection. In agreement with the Maastricht Consensus Report-2 2000, we therefore recommend antibiotic susceptibility testing in specialized centers after the failure of two attempts at H. pylori eradication.