Antibiotic Resistance of <i>Helicobacter pylori</i> and Eradication Rate in Japanese Pediatric Patients

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.

Helicobacter pylori Eradication Efficacy of Therapy Based on the Antimicrobial Susceptibility in Children with Gastritis and Peptic Ulcer in Mekong Delta, Vietnam

“…et al, in Portugal, and Butenko T. et al, in Slovenia, during the period 2013–2017, which considered eradication treatment based on antibiotic sensitivity for 14 days, the percentage of eradication was 97.8% and 85.9%, respectively [ 7 , 13 ]. In Asia, this figure in Ikuse’s study (2016) on Japanese children was 93.8% [ 6 ]. According to a pilot study by Zhang Y.D.…”

“…Further benefits mentioned are the reduction in costs and risks of salvage therapy and, ultimately, the prevention of and reduction in gastric cancer incidence [ 4 , 5 ]. Several researchers worldwide have documented that antibiotic-susceptibility-based eradication of H. pylori in children is highly effective [ 6 , 7 , 8 ]. Furthermore, recent reports on the antibiotic resistance of H. pylori bacteria in Vietnam showed that a very high percentage of H. pylori is resistant to commonly used antibiotics, and the recommended eradication treatment is necessary.…”

Hiệu Quả Điều Trị Tiệt Trừ Helicobacter Pylori Dựa Theo Sự Nhạy Cảm Kháng Sinh Ở Bệnh Nhi Viêm, Loét Dạ Dày-Tá Tràng

“…và cộng sự ở Bồ Đào Nha (2017), điều trị tiệt trừ theo sự nhạy cảm kháng sinh trong 14 ngày, tỷ lệ tiệt trừ đạt 97,8% [11]. Ở Châu Á, nghiên cứu của Ikuse T. và cộng sự ở Nhật Bản (2016) là 93,8% [5]. Có nhiều yếu tố có thể liên quan đến tỷ lệ tiệt trừ thấp trong nghiên cứu của chúng tôi.…”