title: Helicobacter pylori eradication rates in children upon susceptibility testing based on noninvasive stool polymerase chain reaction versus gastric tissue culture.
abstract: OBJECTIVE
  In children with clarithromycin-resistant Helicobacter pylori, clarithromycin-containing therapies often fail. The present study aimed to assess the outcome of tailored therapy upon noninvasive versus invasive H pylori susceptibility testing.
  
  
  METHODS
  A retrospective cohort study was conducted in a pediatric outpatient clinic located in a region where H pylori clarithromycin resistance is highly prevalent. Between June 2007 and September 2009, 96 infected children (mean age 10.8 years), naïve to H pylori eradication treatment, were prescribed triple eradication therapies. These therapies were individually tailored upon susceptibility testing performed either noninvasively using stool polymerase chain reaction (stool PCR group) or invasively using endoscopy, biopsy, and culturing of gastric biopsies (gastric biopsy group). Eradication was defined by negative results upon noninvasive testing including stool PCR at least 5 weeks after the end of treatment.
  
  
  RESULTS
  H pylori was eradicated in 43 of 55 stool PCR group versus 30 of 41 gastric biopsy group children (78.2% vs 73.2%, P = 0.63). Of those H pylori strains with pretherapeutic clarithromycin susceptibility, 78.8% were eradicated in the stool PCR group and 69.2% in the gastric biopsy group (P = 0.41) following clarithromycin-containing therapy; clarithromycin resistance was acquired by 4.1% of strains in the former group versus 12% in the latter (P = 0.33).
  
  
  CONCLUSIONS
  Stool PCR is as effective as the invasive approach of H pylori susceptibility testing for targeting resistance-guided eradication treatments in children. Furthermore, stool PCR is a useful tool for tracking the emergence of clarithromycin resistance following eradication treatment.
authors.affiliation: St. Anna Children's Hospital, Vienna, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Vécsei
authors.forename: Albina
authors.initials: A
authors.lastname: Innerhofer
authors.forename: Ulrike
authors.initials: U
authors.lastname: Graf
authors.forename: Christa
authors.initials: C
authors.lastname: Binder
authors.forename: Heidemarie
authors.initials: H
authors.lastname: Giczi
authors.forename: Karin
authors.initials: K
authors.lastname: Hammer
authors.forename: Andrea
authors.initials: A
authors.lastname: Bruckdorfer
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Hirschl
authors.forename: Athanasios
authors.initials: A
authors.lastname: Makristathis
mesh_terms: D000293:Adolescent; D001317:Austria; D001706:Biopsy; D002648:Child; D017291:Clarithromycin / Q000494:pharmacology; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D004415:Dyspepsia / Q000209:etiology; D005243:Feces / Q000737:chemistry*; D005753:Gastric Mucosa / Q000382:microbiology* / Q000473:pathology; D005756:Gastritis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology; D016480:Helicobacter pylori / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D058889:Molecular Typing; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies
chemical_list: D017291:Clarithromycin