Increasing antimicrobial resistance to clarithromycin and metronidazole in pediatric Helicobacter pylori infection in southern Taiwan: A comparison between two decades

Abstract

Background: Antimicrobial resistance of Helicobacter pylori reduces the eradication rate. This study aimed to investigate changes in antimicrobial susceptibility of H pylori isolated from children in Taiwan in the past two decades. Methods: This study enrolled children receiving esophagogastroduodenoscopy for upper gastrointestinal diseases in a national tertiary referring hospital from 1998 to 2018. H pylori infection was diagnosed by culture. The minimal inhibitory concentrations (MICs) of antibiotics were tested using the E test. The antibiotic resistance rates and MICs of amoxicillin, clarithromycin, metronidazole, levofloxacin, and tetracycline were compared between Results: A total of 70 Helicobacter pylori isolates (29 from 1998 to 2008 and 41 from 2009 to 2018) were identified. The esophagogastroduodenoscopy findings included duodenal ulcers (n = 31), gastric ulcers (n = 9), and gastritis (n = 30). The overall antimicrobial resistance rates of clarithromycin and metronidazole were 22.9% and 21.4%, respectively. The dual resistance rate of clarithromycin and metronidazole was 10%. Resistance rates of levofloxacin and amoxicillin were 8.3% and 2.9%, respectively. None of the isolates were resistant to tetracycline. Compared with the isolates from 1998 to 2008, those from 2009 to 2018 had higher MICs and resistance rates of clarithromycin (26.8% vs 17.2%, P = 0.35) and metronidazole (26.8%vs 13.8%, P = 0.19), but not levofloxacin (9.8% vs 5.3%, P = 1.0) or coresistance to clarithromycin and metronidazole (12.2% vs 6.9%, P = 0.69). Conclusions:The antimicrobial resistance rates of pediatric H pylori isolates to clarithromycin and metronidazole increased during the past decade. The selection of antimicrobial agents other than clarithromycin and metronidazole is crucial to increase pediatric H pylori eradication rates.

Clonal spread of macrolide-resistant Mycoplasma pneumoniae sequence type-3 and type-17 with recombination on non-P1 adhesin among children in Taiwan

“…Use of doxycycline must be considered in patients with fever >72 hours after macrolide treatment. Approximately 87.7% (93/106) of patients with an MRMP infection receiving doxycycline as a secondary agent had reduction of fever within 48 hours, similar to those reported in Japan [31].…”

“…A major potential limitation of this study is that resistance rates were derived from two medical centres and one regional hospital, which may not reflect the entire situation in Taiwan. Clonal spread of macrolide-resistant ST3 and ST17 strains possibly resulted from (a) a type shift phenomenon involving interactions between antigenicity of M. pneumoniae and immunological status of the human population; or (b) increased prescription of macrolide antibiotics in children for respiratory tract infection in Taiwan [31,35]. Differences in clinical presentation were related to age in children with M. pneumoniae infection [36], older patients were more commonly infected by the ST14 strain than the ST3 or ST17 strains, which could indicate that this population had pre-existing immunity against the latter two strains.…”

A Culture-Based Strategy Is More Cost Effective Than an Empiric Therapy Strategy in Managing Pediatric Helicobacter pylori Infection

“…The dual resistant (clarithromycin + metronidazole) and triple resistant (Amoxicillin + clarithromycin + metronidazole) rates of isolates were 10.9 and 1.8%, respectively. The changes of antimicrobial resistant rates of H. pylori isolates in the past two decades had have been shown in previous study ( 14 ).…”

“…Once H. pylori had been isolated, an antimicrobial susceptibility test was performed using the E-test method (bioMerieux Inc., Craponne, France). A strain was considered to be resistant if the minimum inhibitory concentration (MIC) was ≥0.125 μg/ml of amoxicillin, ≥1 μg/ml of clarithromycin, ≥8 μg/ml of metronidazole, ≥1 μg/ml of tetracycline, and ≥1 μg/ml of levofloxacin ( 14 ).…”

Design of Mucoadhesive Nanostructured Polyelectrolyte Complexes Based on Chitosan and Hypromellose Phthalate for Metronidazole Delivery Intended to the Treatment of Helicobacter pylori Infections

“…Although, the triple therapy is the most efficient therapeutic approach, the bacterial resistance to MT is more prevalent than with other antibiotics. In England, between 2000 and 2005, the MT resistance was reported in 25% of the evaluated clinical cases [5].…”