Susceptibility of Helicobacter pylori to antibiotics in Chinese patients.

Objective: Antibiotic resistance to Helicobacter pylori (H. pylori) has been increasing worldwide. The study aimed to evaluate in vitro susceptibility and resistance patterns to antibiotics in empirical H. pylori eradication regimens, and to determine the optimal antibiotics for treatment.

Methods: H. pylori strains (n =181) were obtained from gastric biopsies of patients with upper gastrointestinal symptoms who underwent esophagogastroduodenoscopy from March to December 2013. The susceptibility of H. pylori strains to amoxicillin (AMX), metronidazole (MTZ), clarithromycin (CLR), amoxicillin-clavulanate (AMC), cephalothin (CEP), cefuroxime (CXM), cefixime (CFM), moxifloxacin (MFX) and minocycline (MNO) was determined.

Results: Dual resistance to MTZ + CLR was detected in 48 (26.5%) isolates, MTZ + MFX in 94 (51.9%), and CLR + MFX in 49 (27.1%). Overall, 41 (22.7%) were resistant to MTZ + CLR + MFX. MTZ and CLR resistance rates were significantly associated with the history of H. pylori eradication but there was no significant difference in MFX resistance rates between treated and untreated patients (P = 0.674). No significant relationship was found between antibiotic resistance and patient's gender, age, endoscopic findings, inflammatory severity or gastric atrophy.

Conclusions: AMX, AMC, MNO and cephalosporins, but not MTZ, CLR and MFX, showed good in vitro anti-H. pylori activity. Among cephalosporins, CXM was the most active. H. pylori resistance is higher in patients with previous H. pylori eradication.