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Sung, Chung, Kim, and Lee: Clinical Usefulness of Antimicrobial Susceptibility Test for Helicobacter pylori
Original Article

Korean J Leg Med 2006;26(3):179-184.

Published online: 10 February 2006

DOI: https://doi.org/10.3343/kjlm.2006.26.3.179

Clinical Usefulness of Antimicrobial Susceptibility Test for Helicobacter pylori

Heungsup Sung, M.D.1, Hee-Jung Chung, M.D.1, Mi-Na Kim, M.D.1, Gin Hyug Lee, M.D.2

1Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

2Department of Internal Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

Received 27 February 2006       Revised 5 April 2006       Accepted 8 April 2006

Copyright © 2006 The Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Antimicrobial resistance of Helicobacter pylori is considered as the main cause of failure of eradication therapy. Because resistance to metronidazole has been reported in 25.8% to 66.2% of H. pylori, a combination of proton pump inhibitors (PPI), amoxicillin, and clarithromycin is currently recommended as a primary therapy. We investigated the prevalence of antimicrobial resistance to the primary drugs and the impact of antimicrobial resistance on eradication rates.

Methods

Between May and August 2005, H. pylori isolates from 93 patients were tested for antimicrobial susceptibility at Asan Medical Center. Susceptibility tests of clarithromycin and amoxicillin were performed by the disk diffusion method and those of metronidazole and tetracycline by Etest (AB Biodisk, Solna, Sweden). The medical records of the patients were reviewed to collect the data such as demographic findings, previous and current eradication therapies, and bacteriological outcome. The appropriate therapy was defined as three-drug-combination including susceptible drugs only, or four-drug-combination including metronidazole in the case of metronidazole-resistance.

Results

Resistance rates to clarithromycin and metronidazole were 17.2% and 33.3%, respectively, but there was no resistance to tetracycline and amoxicillin. The eradication was successful in 32 of the 36 patients (88.9%) who received the appropriate therapy, but none of 4 patients who received an inappropriate therapy (P<0.01).

Conclusions

Resistance to clarithromycin seemed to increase and contribute to the failure of eradication therapy. For the appropriate therapy of H. pylori infection, the susceptibility results should be reported before initiation of the eradication therapy.

Keywords: Helicobacter pylori, Antimicrobial resistance, Clarithromycin, Metronidazole, Eradication rates

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Table 1.
Interpretative standard for antimicrobial susceptibility testing
Antimicrobials Method Resistance*
Amoxicillin 10 μg disk <25 mm
Clarithromycin 15 μg disk <21 mm
Metronidazole Etest >8 μg/mL
Tetracycline Etest >16 μg/mL

* References[19–21].

Table 2.
Susceptibility of 93 clinical isolates of H. pylori against clarithromycin and metronidazole
Antimicrobial susceptibility N of isolates (%)
C-S/M-S 51 (54.8)
C-S/M-R 26 (28.0)
C-R/M-S 11 (11.8)
C-R/M-R 5 (5.4)
Total 93 (100.0)

Abbreviations: C-S, clarithromycin-sensitive; C-R, clarithromycin-resistant; M-S, metronidazole sensitive; M-R, metronidazole-resistant.

Table 3.
Treatment regimens and clinical outcome
Antimicrobial susceptibility N of patients treated with/N of bacteriologic follow-up /N of patients cured
 Total
PAC PBMT PACM PAM PBMTA
C-S/M-S 34/19/18   1/0/-     35/19/18
C-S/M-R 18/12/10     1/1/0   19/13/10
C-R/M-S 3/2/0 4/2/2       7/4/2
C-R/M-R   2/2/1 1/1/0   1/1/1 4/4/2
Total 55/33/28 6/4/3 2/1/0 1/1/0 1/1/1 65/40/32

Abbreviations: C-S, clarithromycin-sensitive; C-R, clarithromycin-resistant; M-S, metronidazole sensitive; M-R, metronidazole-resistant; P, proton pump inhibitor; A, amoxicillin; C, clarithromycin; B, bismuth; M, metronidazole; T, tetracycline.

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