title: Primary Antibiotic Resistance to Helicobacter pylori Strains Isolated From Children in Northern Iran: A Single Center Study.
abstract: BACKGROUND
  Initial resistance to antibiotics is the main reason for the failure of Helicobacter pylori (H. pylori) eradication in children.
  
  
  OBJECTIVE
  As we commonly face high antibiotic resistance rates in children, we aimed to determine the susceptibility of H. pylori to common antibiotics.
  
  
  METHODS
  In this cross-sectional in vitro study, 169 children younger than 14 years with clinical diagnosis of peptic ulcer underwent upper gastrointestinal endoscopy. Biopsy specimens from stomach and duodenum were cultured. In isolated colonies, tests of catalase, urease, and oxidase as well as gram staining were performed. After confirming the colonies as H. pylori, the antibiogram was obtained using disk diffusion method.
  
  
  RESULTS
  Culture for H. pylori was positive in 12.3% of the specimens, urease test in 21.3%, serological test in 18.9% and stool antigen test was positive in 21.9%. We could show high specificity but moderate sensitivity of both histological and H. pylori stool antigen tests to detect H. pylori. The overall susceptibility to metronidazole was 42.9%, amoxicillin 95.2%, clarithromycin 85.7%, furazolidone 61.9%, azithromycin 81.0%, and tetracycline 76.2% with the highest resistance to metronidazole and the lowest to clarithromycin.
  
  
  CONCLUSIONS
  In our region, there is high resistance of H. pylori to some antibiotics including metronidazole and furazolidone among affected children. To reduce the prevalence of this antibiotic resistance, more controlled use of antibiotics should be considered in children.
authors.affiliation: Department of Pediatrics, 17th Shahrivar Hospital, Guilan University of Medical Sciences, Rasht, IR Iran.
authors.forename: Shohreh
authors.initials: S
authors.lastname: Maleknejad
authors.affiliation: Department of Pediatrics, 17th Shahrivar Hospital, Guilan University of Medical Sciences, Rasht, IR Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Mojtahedi
authors.affiliation: Department of Pediatrics, 17th Shahrivar Hospital, Guilan University of Medical Sciences, Rasht, IR Iran.
authors.forename: Afshin
authors.initials: A
authors.lastname: Safaei-Asl
authors.affiliation: Department of Pediatrics, 17th Shahrivar Hospital, Guilan University of Medical Sciences, Rasht, IR Iran.
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Taghavi
authors.affiliation: Department of Pediatrics, 17th Shahrivar Hospital, Guilan University of Medical Sciences, Rasht, IR Iran.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Kazemnejad
keywords: Antibiotics; Children; Culture; Helicobacter pylori; Resistance