Summary auto-generated
This study examined antibiotic resistance patterns in 1,644 clinical Helicobacter pylori isolates collected from patients in northeastern Germany between 1995 and 2000. Resistance was determined using the Etest method to measure minimum inhibitory concentrations for clarithromycin, amoxicillin, metronidazole, and tetracycline. The overall primary resistance rate was 26.2% for metronidazole and 2.2% for clarithromycin, with no resistance detected to amoxicillin or tetracycline. Importantly, resistance rates remained stable throughout the 6-year study period. PCR-RFLP analysis of 36 clarithromycin-resistant isolates identified point mutations in the 23S rRNA gene: 52.8% carried an A→G transition at position 2143 and 36.1% at position 2142. Metronidazole resistance was slightly more prevalent in isolates from female patients. The study concluded that clarithromycin-based triple therapy remained suitable as first-line H. pylori eradication therapy in this German region, as clarithromycin resistance rates were comparatively low relative to other geographic areas.
Key findings
- Metronidazole resistance was 26.2% and clarithromycin resistance was 2.2%, both remaining stable over 6 years in northeastern Germany
- No resistance to amoxicillin or tetracycline was observed in any of the 1,644 isolates tested
- Point mutations at positions 2142 and 2143 in the 23S rRNA gene accounted for clarithromycin resistance in most analyzed isolates
- Metronidazole resistance was slightly more common in female patients (32.2%) compared to male patients (20.8%)
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Abstract
The issue of antibiotic resistance in Helicobacter pylori is of particular concern and has become an important factor leading to eradication failure. This paper reports the prevalence of primary resistance to clarithromycin, amoxicillin, metronidazole and tetracycline among H. pylori isolates in the north-eastern part of Germany. A total of 1644 clinical H. pylori isolates was investigated over a period of 6 years from 1995 to 2000. The MICs were determined by the Etest. The overall rate of primary resistance was 26.2% for metronidazole and 2.2% for clarithromycin. No significant changes in the resistance rates during the period of investigation were observed. No isolate was resistant to amoxicillin or tetracycline. PCR-RFLP analysis for the detection of point mutations associated with clarithromycin resistance was performed with 36 H. pylori isolates. The A G transition mutation at position 2143 was detected in 19 H. pylori isolates (52.8%), whereas the mutation at position 2142 was found in 13 isolates (36.1%).