General and acute paediatrics
Antibiotic resistance and antibiotic sensitivity based treatment
in Helicobacter pylori infection: advantages
and outcome
M E Streeta, P Caruanab, C Caffarellia, W Maglianic, M Manfredia, F Fornarolia, G L de'Angelisa
a Department of
Paediatrics, University of Parma, Italy, b Department of Pathology, University
of Parma, c Department of
Microbiology, University of Parma
Correspondence to: Dr G L de'Angelis, Istituto di Clinica Pediatrica, Via Gramsci, 14, 43100 Parma, Italy deangelis{at}pleo.it
Accepted 9 January
2001
AIMS
To compare two strategies for
the eradication of Helicobacter pylori infection.
METHODSGroups 1 and 2 each
consisted of 75 consecutive patients. Patients in group 1 were treated
with two antibiotics based on antibiotic susceptibility testing; those
in group 2 received amoxycillin and clarithromycin for eight days,
together with either ranitidine or omeprazole. Eradication rate was
assessed in both groups six months after treatment.
RESULTSIn group 1, H pylori grew in culture in 63/75 cases.
Susceptibility testing showed that 35/63 isolates were resistant to
metronidazole, 10/63 to clarithromycin, 2/63 to ampicillin, 1/63 to
tetracycline, and 5/63 to both clarithromycin and metronidazole. In
group 1 the infection was eradicated in 96% of the initial 75 subjects, and in 98% of the subjects treated according to the
antibiotic assay (62/63). As two patients were lost at follow up the
overall eradication rate was 99%. In group 2, eradication was achieved in 61/75 subjects (81%). This was significantly lower than the percentage of eradication observed in group 1 (81% versus 99%).
CONCLUSIONSAntibiotic
susceptibility tests are useful in childhood as a very high percentage
of subjects are cured. This approach is costly, but selective
antibiotic treatment contributes to limit further development of
antibiotic resistance, and money is saved in terms of reinvestigation
and further repeated treatments.
Keywords: H pylori; antibiotic resistance; antibiotic susceptibility assay; eradication
© 2001 by Archives of Disease in Childhood
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