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Helicobacter pylori Clarithromycin Resistance and Treatment Failure Are Common in the USA

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Abstract

Background

Helicobacter pylori antibiotic resistance leads to frequent treatment failure. However, the current US prevalence of H. pylori clarithromycin resistance and treatment failure is unknown.

Aims

To determine the prevalence of clarithromycin-resistant H. pylori and its impact on treatment failure in the USA.

Methods

A multicenter, retrospective, cohort study for clarithromycin-resistant H. pylori was conducted over four academic medical centers in different geographic regions of the USA. Gastric biopsy material, residual from standard clinical pathologic examination, was examined for clarithromycin resistance by DNA sequencing of H. pylori 23S rRNA.

Results

One hundred and twenty-four cases of H. pylori gastritis were examined from medical centers in four different geographic regions of the USA. The overall prevalence of clarithromycin resistance was 32.3 % (range 23.1–45.8 %). There was no significant difference in the prevalence of clarithromycin resistance by study site, gender, age, or race/ethnicity. In a subset of 67 patients that had clinical follow-up data, the overall prevalence of clarithromycin resistance was 31.3 %. There was a 2.9-fold increase (p = 0.002) in treatment failure for cases with clarithromycin resistance (57.1 %) compared to wildtype H. pylori (19.6 %).

Conclusions

H. pylori clarithromycin resistance in the USA exceeds the estimated 20 % prevalence compatible with successful empiric antibiotic therapy. This resistance resulted in a significant rate of treatment failure in all sites surveyed. Empiric therapy in the USA should be used with caution until there is better regional or local determination of H. pylori antibiotic resistance.

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Acknowledgments

We thank David Y. Graham, MD, Baylor College of Medicine, for assistance in the development of the clarithromycin resistance test (23S rRNA).

Author information

Author notes

  1. Elizabeth Coss

    Present address: Texas Digestive Disease Consultants, Dallas, TX, USA

Authors and Affiliations

  1. Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Jason Y. Park

  2. Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Jason Y. Park

  3. Department of Pathology, Children’s Health Dallas, 1935 Medical District Drive, Dallas, TX, 75235, USA

    Jason Y. Park & Midori Mitui

  4. Medical Service, Dallas Veterans Affairs Medical Center, Dallas, TX, USA

    Kerry B. Dunbar & Byron Cryer

  5. Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Kerry B. Dunbar, Elizabeth Coss & Byron Cryer

  6. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Kerry B. Dunbar, Chinemerem Okwara, Elizabeth Coss & Byron Cryer

  7. Department of Pathology, Ohio State University Wexner Medical Center, Columbus, OH, USA

    Christina A. Arnold

  8. Department of Pathology and Lab Medicine, Mayo Clinic, Arizona, Scottsdale, AZ, USA

    Dora M. Lam-Himlin

  9. Division of Anatomic Pathology, Department of Pathology, University of California, San Diego, San Diego, CA, USA

    Mark A. Valasek & Irene Thung

  10. Department of Pathology, Virginia Commonwealth University Health System, Richmond, VA, USA

    Christopher D. Doern

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  1. Jason Y. Park
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Corresponding author

Correspondence to Jason Y. Park.

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Park, J.Y., Dunbar, K.B., Mitui, M. et al. Helicobacter pylori Clarithromycin Resistance and Treatment Failure Are Common in the USA. Dig Dis Sci 61, 2373–2380 (2016). https://doi.org/10.1007/s10620-016-4091-8

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  • DOI: https://doi.org/10.1007/s10620-016-4091-8

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