Surveillance of Helicobacter pylori antibiotic resistance in England and Wales

Treatment of H. pylori infections of the gastric mucosa normally involves triple therapy comprising two antibiotics such as the macrolide clarithromycin, the nitroimidazole metronidazole and or amoxicillin in combination with a proton pump inhibitor such as omeprazole. Approximately 10% of patients fail treatment and that may be due to the development of antibiotic resistance, the extent of which will depend on the patient population. Resistance to metronidazole occurs in approximately 50% of infected individuals in many European countries with significantly higher levels of up to 90% in developing countries. Resistance to clarithromycin is currently less common with levels below 10% in many European countries although there is evidence that rates may be increasing. Significantly, a recent meta-analysis has shown that pretreatment resistance to clarithromycin can reduce the effectiveness of therapy by 55%.

In the UK, as in most other countries, there is no routine surveillance of H. pylori antibiotic resistance. However, over the past two years, the Helicobacter Reference Unit has initiated several local surveillance studies in conjunction with PHLs in Chelmsford and Bangor, and PHLS Collaborating centres at St George's hospital and University College Hospitals London. Findings to date show that metronidazole resistance is highest in London (63%) compared to 37% in Chelmsford and 20% in Bangor. By contrast, clarithromycin resistance rates were 11% for London, 4.9% for Bangor and 4.4% for Chelmsford. To date, no strains with resistance to amoxicillin or to tetracycline have been detected. It is hoped to expand this surveillance activity in conjunction with other centres.

 

Last reviewed: 2 December 2008

• Surveillance of Helicobacter pylori antibiotic resistance in England and Wales
  Treatment of H. pylori infections of the gastric mucosa normally involves triple therapy comprising two antibiotics in combination with a proton pump inhibitor.
  Added/updated: 2 December 2008