Helicobacter pylori culture and antimicrobial susceptibility from pediatric patients in Michigan.
BACKGROUND
We recently observed a high failure rate in the eradication of Helicobacter pylori infection in children with 2-week triple therapy using lansoprazole, amoxicillin and clarithromycin. We performed a prospective evaluation of antral biopsies of all children subsequently diagnosed with H. pylori gastritis for culture and antimicrobial susceptibility assessment.


METHODS
All children with antral nodularity and/or an elevated anti-H. pylori IgG titer underwent antral biopsies for histology, urease test and culture while undergoing an upper endoscopy for routine indications. All positive cultures were tested for antimicrobial susceptibility by E-test for clarithromycin, amoxicillin, tetracycline and metronidazole.


RESULTS
Thirty-one children (16 male, 15 female) between 2 and 19 years of age were diagnosed with H. pylori gastritis by histology. However, culture was positive in only 22 of 31 (71%) patients. The E-test in vitro antimicrobial susceptibility testing revealed that 95.6% of the isolates were susceptible to amoxicillin, 59% to clarithromycin and 54.6% to metronidazole. There was no resistance to tetracycline.


CONCLUSIONS
Evaluation of antibiotic resistance profiles from pediatric patients from different geographic areas can help in optimizing therapeutic regimen to prevent treatment failures. Metronidazole and clarithromycin resistance is much higher in our pediatric population than reported in adults and could be a major contributor to failure of H. pylori eradication.
Tolia
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Division of Pediatric Gastroenterology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201, USA.
Brown
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W
El-Baba
M
M
Lin
C H
CH
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D003470:Culture Media; D004352:Drug Resistance, Microbial; D005260:Female; D005756:Gastritis / Q000382:microbiology*; D016481:Helicobacter Infections / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects* / Q000254:growth & development* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008824:Michigan; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies
D000900:Anti-Bacterial Agents; D003470:Culture Media