From Nobel to no cure: a case for monitoring antibiotic resistance in the gastric pathogen<i>Helicobacter pylori</i>

Chisholm, Stephanie; Owen, Robert J.

doi:10.1586/14787210.4.3.349

Cited by 2 publications

(4 citation statements)

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“…As resistance of H. pylori to several agents varied significantly between the two general hospitals, more centres, including areas with ethnic groups, should be involved in surveillance in any country, so that we can inform first and second line H. pylori treatment guidance. A surveillance system is a much cheaper alternative to antibiotic susceptibility testing on an individual patient basis . It is clear from our study that implementing a H. pylori surveillance system is feasible, however, it is our judgement that substantial funding is required to support it.…”

Section: Discussionmentioning

confidence: 87%

“…A surveillance system is a much cheaper alternative to antibiotic susceptibility testing on an individual patient basis. 10 It is clear from our study that implementing a H. pylori surveillance system is feasible, however, it is our judgement that substantial funding is required to support it. Interested staff would be needed at participating sites in both endoscopy and microbiology, whereas administrative support would be required to collate the data including the accurate collection of antibiotic use from primary care records.…”

Section: Implications For Policymakersmentioning

confidence: 88%

“…Most patients are prescribed H. pylori treatment without culture and antibiotic susceptibility testing as current NICE dyspepsia guidance recommends that patients with recurrent dyspepsia should be tested for H. pylori using a non‐invasive breath or faecal antigen test . The Maastricht III Consensus recommends surveillance of primary H. pylori antibiotic resistance to inform guidance for empirical first‐line treatment . They also recommend that clarithromycin should no longer be prescribed for H. pylori if local resistance is above 15–20%.…”

Section: Introductionmentioning

confidence: 99%

“…1 The Maastricht III Consensus recommends surveillance of primary H. pylori antibiotic resistance to inform guidance for empirical first-line treatment. 4,10 They also recommend that clarithromycin should no longer be prescribed for H. pylori if local resistance is above 15-20%. A two centre longitudinal UK study between 2000 and 2005 showed that H. pylori resistance to clarithromycin increased from 6% to 13%.…”

Section: Introductionmentioning

confidence: 99%

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Is Helicobacter pylori antibiotic resistance surveillance needed and how can it be delivered?

McNulty

Lasseter

Shaw

et al. 2012

Aliment Pharmacol Ther

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Summary Background Most patients are prescribed Helicobacter pylori treatment without culture and antibiotic susceptibility testing, as current guidance recommends that patients with recurrent dyspepsia should be tested for H. pylori using a non‐invasive breath or faecal antigen test. Aims To determine the prevalence of H. pylori antibiotic resistance in patients attending endoscopy in England and Wales, and the feasibility of an antibiotic resistance surveillance programme testing. Methods We tested the antibiotic susceptibility of H. pylori isolates from biopsy specimens from 2063 of 7791 (26%) patients attending for endoscopy in Gloucester and Bangor, and 339 biopsy specimens sent to the Helicobacter Reference Unit (HRU) in London. Culture and susceptibility testing was undertaken in line with National and European methods. Results Helicobacter pylori were cultured in 6.4% of 2063 patients attending Gloucester and Bangor hospitals. Resistance to amoxicillin, tetracycline and rifampicin/rifabutin was below 3% at all centres. Clarithromycin, metronidazole and quinolone resistance was significantly higher in HRU (68%, 88%, 17%) and Bangor isolates (18%, 43%, 13%) than Gloucester (3%, 22%, 1%). Each previous course of these antibiotics is associated with an increase in the risk of antibiotic resistance to that agent [clarithromycin: RR = 1.5 (P = 0.12); metronidazole RR = 1.6 (P = 0.002); quinolone RR = 1.8 (P = 0.01)]. Conclusions Helicobacter pylori infection is now uncommon in dyspeptic patients at endoscopy. A surveillance system is feasible and necessary to inform dyspepsia management guidance. Clinicians should take a thorough antibiotic history before prescribing metronidazole, clarithromycin or levofloxacin for H. pylori.

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Section: Discussionmentioning

confidence: 87%

Section: Implications For Policymakersmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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