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

Abstract

Background: The efficacy of Helicobacter pylori (H. pylori) eradication therapy for children is currently low, and antibiotic resistance is a significant cause of treatment failure. The purpose of this study was to evaluate the H. pylori eradication efficacy of therapy based on antimicrobial susceptibility in pediatric patients with gastritis and peptic ulcer. Methods: This study was conducted at Can Tho Children’s Hospital and Can Tho University of Medicine and Pharmacy Hospital between March 2019 and April 2022. We performed an upper gastrointestinal endoscopy, cultured H. pylori from biopsies of gastric mucosa, determined antibiotic sensitivities to H. pylori by the E-test method, and treated eradication based on the antibiotic susceptibilities of bacteria. After at least 4 weeks of eradication therapy, we assessed the effectiveness of treatment with a breath test. Results: Among 237 children recruited in this study, 48.9% were boys and 51.1% were girls, and the mean age was 10.03 ± 2.53 years. We determined that 80.6% of H. pylori were resistant to clarithromycin, as well as amoxicillin, metronidazole, levofloxacin, and tetracycline, at 71.7%, 49.4%, 45.1%, and 11.4%, respectively. The overall eradication rate of H. pylori was 83.1% (172/207). Among therapies tailored to antimicrobial susceptibility, the bismuth quadruple regimen achieved the greatest success, but the efficacy of triple therapy with esomeprazole + AMX + CLR/MTZ was low. Conclusions: Tailored eradication therapy was highly successful in our study but did not achieve over 90%. We recommend that in countries with a high prevalence of antibiotic resistance in H. pylori strains, particularly where the amoxicillin-resistance rate of H. pylori is high, therapy tailored to antimicrobial susceptibility should be used as first-line therapy, and bismuth and tetracycline should be added to enhance the eradication efficacy in children.

Antibiotic Resistance of Helicobacter pylori in Patients with Peptic Ulcer

“…No strain was resistant to all five tested antibiotics. Our results are similar to other studies in Vietnam and around the world carried out in recent years [ 14 , 15 , 21 , 25 , 26 ]. However, the rate of antibiotic resistance is higher than in another study conducted in Vietnam in 2008.…”

“…This study also evaluated dual resistance with AMX–CLR, AMX–MTZ, AMX–LEV, CLR–MTZ, and MTZ–TET to help clinicians see the risk of failure in eradicating H. pylori when choosing the corresponding empiric regimen. Multidrug resistance was defined as the strain being resistant to three or more antibiotics [ 14 , 15 ].…”

Helicobacter pylori antibiotic resistance profile in Chinese children with upper gastrointestinal symptoms and a literature review for developing personalized eradicating strategies

“…In a study performed in Wenzhou, Zhejiang province, China, when CLA resistance reached 26.12%, the efficacies of triple therapy and bismuth-containing quadruple therapy based on the antibiotic susceptibility test were 67.32% and 68.49%, respectively ( Pan et al, 2020 ). Studies in Vietnam revealed increased resistance to CLA, with rates of 50.9% in 2006 ( Le et al, 2022 ), 84.6% in 2012 ( Le et al, 2022 ), 92.1% in 2021 ( Van Thieu et al, 2021 ), and 81% in 2022 ( Borka et al, 2023 ). The success rate of treatment based on antimicrobial testing is 75% in Vietnam ( Nguyen et al, 2012 ).…”

A Survey of Pharmacists and Other Healthcare Professionals in Vietnam: Factors Influencing Knowledge and Attitudes Toward Reporting Adverse Drug Reactions

“…Data collection was conducted among healthcare professionals at a public hospital in Vinh Long province, Vietnam. Vinh Long province is located in the Mekong Delta region, 26 approximately 135 km southwest of Ho Chi Minh City. 27 Vinh Long’s economy is growing rapidly compared to that of other provinces in Vietnam.…”