title: Changing antimicrobial susceptibility epidemiology of Helicobacter pylori strains in Japan between 2002 and 2005.
abstract: Surveillance of Helicobacter pylori antimicrobial susceptibility reflecting the general population in Japan is limited. The antimicrobial susceptibilities of 3,707 H. pylori strains isolated from gastric mucosa samples of previously untreated patients diagnosed with gastroduodenal diseases at 36 medical facilities located throughout Japan between October 2002 and September 2005 were evaluated. Using an agar dilution method for antimicrobial susceptibility testing of H. pylori, the MIC distributions and trends during the study period for clarithromycin, amoxicillin, and metronidazole were studied. While the MIC(50) and MIC(90) for clarithromycin did not change during the 3-year period, the MIC(80) showed a 128-fold increase. Furthermore, the rate of resistance increased yearly from 18.9% (2002 to 2003) to 21.1% (2003 to 2004) and 27.7% (2004 to 2005). With a resistance rate of 19.2% among males compared to 27.0% among females, a significant gender difference was observed (P < 0.0001). Our study shows that in Japan, there is an evolving trend towards increased resistance to clarithromycin with geographical and gender differences as well as between clinical disease conditions. No significant changes in resistance were observed for amoxicillin and metronidazole during the period. While the benefit of H. pylori antimicrobial susceptibility testing has been debated in Japan, current empirical regimens are not based on susceptibility data representative of the general population. The development of an effective H. pylori eradication regimen in Japan will require continued resistance surveillance as well as a better understanding of the epidemiology of resistance.
authors.affiliation: Chemotherapy Division, Mitsubishi Chemical Medience Corporation, Tokyo, Japan. mbc-ka@sa2.so-net.ne.jp
authors.forename: Intetsu
authors.initials: I
authors.lastname: Kobayashi
authors.forename: Kazunari
authors.initials: K
authors.lastname: Murakami
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Kato
authors.forename: Seiichi
authors.initials: S
authors.lastname: Kato
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
authors.forename: Shin'ichi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Katsuyama
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Ken
authors.initials: K
authors.lastname: Haruma
authors.forename: Masaru
authors.initials: M
authors.lastname: Nasu
authors.forename: Toshio
authors.initials: T
authors.lastname: Fujioka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000494:pharmacology*; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002648:Child; D017291:Clarithromycin / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D005260:Female; D005753:Gastric Mucosa / Q000382:microbiology; D016481:Helicobacter Infections / Q000453:epidemiology / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008795:Metronidazole / Q000494:pharmacology*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012737:Sex Factors
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin