title: Helicobacter pylori resistance rates for levofloxacin, tetracycline and rifabutin among Irish isolates at a reference centre.
abstract: BACKGROUND
  Helicobacter pylori eradication rates using conventional triple therapies are falling, making viable second-line and rescue regimens necessary. Levofloxacin, tetracycline and rifabutin are three efficacious antibiotics for rescue therapy.
  
  
  OBJECTIVE
  We aimed to assess the resistance rates for H. pylori against these antibiotics in an Irish cohort.
  
  
  METHODS
  Gastric biopsies were collected from 85 patients infected with H. pylori (mean age 46 years) in the Adelaide and Meath Hospital, Dublin in 2008 and 2009. Susceptibility to antibiotics was tested using the Etest. Clinical information was obtained from endoscopy reports and chart review.
  
  
  RESULTS
  50.6 % of patients were females. Mean age was 47 years. Ten had prior attempts at eradication therapy with amoxicillin-clarithromycin-PPI, two had levofloxacin-based second-line therapy. 11.7 % [95 % CI (6.5-20.3 %)] (N = 10) had strains resistant to levofloxacin. There were no strains resistant to rifabutin or tetracycline. Levofloxacin resistance in the under 45 age group was 2.6 % (1/38) compared to 19.1 % (9/47) of above 45 age group (p = 0.02).
  
  
  CONCLUSIONS
  The levofloxacin rates illustrated in this study are relatively low by European standards and in line with other studies from the United Kingdom and Germany, with younger patients having very low levels of resistance. Levofloxacin, tetracycline and rifabutin are all valid options for H. pylori eradication in Irish patients but the importance of compliance cannot be underestimated.
authors.affiliation: Department of Gastroenterology, Adelaide and Meath Hospital incorporating the National Children's Hospital/Trinity College Dublin, Belgard Road, Tallaght, Dublin 24, Ireland, jpanthonyoconnor@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: O'Connor
authors.forename: I
authors.initials: I
authors.lastname: Taneike
authors.forename: A
authors.initials: A
authors.lastname: Nami
authors.forename: N
authors.initials: N
authors.lastname: Fitzgerald
authors.forename: B
authors.initials: B
authors.lastname: Ryan
authors.forename: N
authors.initials: N
authors.lastname: Breslin
authors.forename: H
authors.initials: H
authors.lastname: O'Connor
authors.forename: D
authors.initials: D
authors.lastname: McNamara
authors.forename: P
authors.initials: P
authors.lastname: Murphy
authors.forename: C
authors.initials: C
authors.lastname: O'Morain
mesh_terms: D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001706:Biopsy; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007494:Ireland; D064704:Levofloxacin / Q000627:therapeutic use*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017828:Rifabutin / Q000627:therapeutic use*; D013270:Stomach / Q000382:microbiology; D013752:Tetracycline / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017828:Rifabutin; D064704:Levofloxacin; D013752:Tetracycline