title: Is Helicobacter pylori antibiotic resistance surveillance needed and how can it be delivered?
abstract: BACKGROUND
  Most patients are prescribed Helicobacter pylori treatment without culture and antibiotic susceptibility testing, as current guidance recommends that patients with recurrent dyspepsia should be tested for H. pylori using a non-invasive breath or faecal antigen test.
  
  
  OBJECTIVE
  To determine the prevalence of H. pylori antibiotic resistance in patients attending endoscopy in England and Wales, and the feasibility of an antibiotic resistance surveillance programme testing.
  
  
  METHODS
  We tested the antibiotic susceptibility of H. pylori isolates from biopsy specimens from 2063 of 7791 (26%) patients attending for endoscopy in Gloucester and Bangor, and 339 biopsy specimens sent to the Helicobacter Reference Unit (HRU) in London. Culture and susceptibility testing was undertaken in line with National and European methods.
  
  
  RESULTS
  Helicobacter pylori were cultured in 6.4% of 2063 patients attending Gloucester and Bangor hospitals. Resistance to amoxicillin, tetracycline and rifampicin/rifabutin was below 3% at all centres. Clarithromycin, metronidazole and quinolone resistance was significantly higher in HRU (68%, 88%, 17%) and Bangor isolates (18%, 43%, 13%) than Gloucester (3%, 22%, 1%). Each previous course of these antibiotics is associated with an increase in the risk of antibiotic resistance to that agent [clarithromycin: RR = 1.5 (P = 0.12); metronidazole RR = 1.6 (P = 0.002); quinolone RR = 1.8 (P = 0.01)].
  
  
  CONCLUSIONS
  Helicobacter pylori infection is now uncommon in dyspeptic patients at endoscopy. A surveillance system is feasible and necessary to inform dyspepsia management guidance. Clinicians should take a thorough antibiotic history before prescribing metronidazole, clarithromycin or levofloxacin for H. pylori.
authors.affiliation: Primary Care Unit, Health Protection Agency, Gloucestershire Royal Hospital, Gloucester, UK. cliodna.mcnulty@hpa.org.uk
authors.forename: C A M
authors.initials: CA
authors.lastname: McNulty
authors.forename: G
authors.initials: G
authors.lastname: Lasseter
authors.forename: I
authors.initials: I
authors.lastname: Shaw
authors.forename: T
authors.initials: T
authors.lastname: Nichols
authors.forename: S
authors.initials: S
authors.lastname: D'Arcy
authors.forename: A J
authors.initials: AJ
authors.lastname: Lawson
authors.forename: E
authors.initials: E
authors.lastname: Glocker
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use; D004352:Drug Resistance, Microbial / Q000187:drug effects*; D004415:Dyspepsia / Q000188:drug therapy*; D004724:Endoscopy; D004739:England; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests / Q000379:methods; D015242:Ofloxacin / Q000627:therapeutic use; D012307:Risk Factors; D014852:Wales
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D064704:Levofloxacin; D015242:Ofloxacin; D017291:Clarithromycin