Format

Send to

Choose Destination
Dig Dis Sci. 2016 Aug;61(8):2373-80. doi: 10.1007/s10620-016-4091-8. Epub 2016 Feb 29.

Helicobacter pylori Clarithromycin Resistance and Treatment Failure Are Common in the USA.

Author information

1
Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA. jason.park@childrens.com.
2
Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, USA. jason.park@childrens.com.
3
Department of Pathology, Children's Health Dallas, 1935 Medical District Drive, Dallas, TX, 75235, USA. jason.park@childrens.com.
4
Medical Service, Dallas Veterans Affairs Medical Center, Dallas, TX, USA.
5
Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
6
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
7
Department of Pathology, Children's Health Dallas, 1935 Medical District Drive, Dallas, TX, 75235, USA.
8
Department of Pathology, Ohio State University Wexner Medical Center, Columbus, OH, USA.
9
Department of Pathology and Lab Medicine, Mayo Clinic, Arizona, Scottsdale, AZ, USA.
10
Division of Anatomic Pathology, Department of Pathology, University of California, San Diego, San Diego, CA, USA.
11
Texas Digestive Disease Consultants, Dallas, TX, USA.
12
Department of Pathology, Virginia Commonwealth University Health System, Richmond, VA, USA.

Abstract

BACKGROUND:

Helicobacter pylori antibiotic resistance leads to frequent treatment failure. However, the current US prevalence of H. pylori clarithromycin resistance and treatment failure is unknown.

AIMS:

To determine the prevalence of clarithromycin-resistant H. pylori and its impact on treatment failure in the USA.

METHODS:

A multicenter, retrospective, cohort study for clarithromycin-resistant H. pylori was conducted over four academic medical centers in different geographic regions of the USA. Gastric biopsy material, residual from standard clinical pathologic examination, was examined for clarithromycin resistance by DNA sequencing of H. pylori 23S rRNA.

RESULTS:

One hundred and twenty-four cases of H. pylori gastritis were examined from medical centers in four different geographic regions of the USA. The overall prevalence of clarithromycin resistance was 32.3 % (range 23.1-45.8 %). There was no significant difference in the prevalence of clarithromycin resistance by study site, gender, age, or race/ethnicity. In a subset of 67 patients that had clinical follow-up data, the overall prevalence of clarithromycin resistance was 31.3 %. There was a 2.9-fold increase (p = 0.002) in treatment failure for cases with clarithromycin resistance (57.1 %) compared to wildtype H. pylori (19.6 %).

CONCLUSIONS:

H. pylori clarithromycin resistance in the USA exceeds the estimated 20 % prevalence compatible with successful empiric antibiotic therapy. This resistance resulted in a significant rate of treatment failure in all sites surveyed. Empiric therapy in the USA should be used with caution until there is better regional or local determination of H. pylori antibiotic resistance.

KEYWORDS:

23S rRNA; Antibiotic resistance; Clarithromycin; Helicobacter pylori; Treatment failure

PMID:
26923948
DOI:
10.1007/s10620-016-4091-8
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center