TITLE:
Antibiotic Resistance of Helicobacter pylori and Eradication Rate in Japanese Pediatric Patients
AUTHORS:
Tamaki Ikuse, Yo Aoyagi, Naho Obayashi, Keisuke Jimbo, Takahiro Kudo, Yoshikazu Ohtsuka, Thomas G. Blanchard, Steven J. Czinn, Toshiaki Shimizu
KEYWORDS:
Resistance, Eradication Rate, Susceptibility Test, Clarithromycin, Metronidazole
JOURNAL NAME:
Advances in Microbiology,
Vol.7 No.4,
April
19,
2017
ABSTRACT: Helicobacter pylori (H. pylori) eradication rates achieved with a proton pump inhibitor (PPI),
amoxicillin and clarithromycin have recently decreased to about 75% because of
the increase in clarithromycin resistance in Japan. In the present study, H. pylori resistance rates against
clarithromycin, amoxicillin and metronidazole were investigated in pediatric patients
and eradication rates were evaluated when tailored antibiotics regimens based
on antibiotic sensitivity data were used. We isolated H. pylori endoscopically from 77 pediatric patients suffering from abdominal symptoms. The susceptibility
tests of H. pylori strains to clarithromycin,
amoxicillin and metronidazole were examined and eradication therapy was tailored
using the appropriate antibiotics. Seventy-seven patients were treated with a
mean age of 12.16 ± 3.34 years (range, 4.92-19.75) consisting of 40 males and
37 females. The average resistance rates between 1998 and 2016 to
clarithromycin, amoxicillin and metronidazole were 54.5% (42 of 77), 6.5% (5 of
77) and 5.2% (4 of 77) respectively. The prevalence of clarithromycin
resistance increased significantly over time to reach 88.9% by 2013-2016.
Successful eradication rates using tailored antibiotic treatment was 93.8% (61
of 65). Clarithromycin-based eradication therapy rate reached 92.6% against
clarithromycin-sensitive strains. Metronidazole-based initial eradication
therapy also had a high successful rate (97.0%) to clarithromycin-resistant
strains. Although high rates of clarithromycin resistant H. pylori reaching about 90% were
observed in Japanese children, tailored eradication therapy using the
appropriate antibiotic agents were highly successful. H. pylori sensitivity testing and eradication therapy with
appropriate antibacterial agents may contribute to accomplishment of high
initial eradication rates and consequently reducing the incidence of developing
gastric cancer.