Evolution of resistance to clarithromycin and metronidazole in Helicobacter pylori Spanish clinical isolates

Lopez-Brea, M.; Domingo, D.; Villar, H.; Martinez, M.J.; Hernandet, J.M.; Alarcon, T.
September 2002
Gut;Sep2002 Supplement 2, Vol. 51, pA2
Academic Journal
The aim of this study was to determine the in vitro susceptibility of amoxicillin, tetracycline, clarithromycin and metronidazole in Spanish H. pylori strains from 1994 to 2002. Material and methods: A total of 770 H. pylori strains were studied from patients attended in Hospital San Agustin, Avilés (270 adult patients), Hospital de la Inmaculada, Almeria (198 adult patients) or Hospital del Niño Jesus, Madrid (279 paediatric patients). A total of 259 strains were studied in the period 1994-1995, 233 in 1996-1997, 143 in 1998-1999 and 135 in 2000-2002. Susceptibility to the 4 antibiotics was determined by an agar dilution method according to the NCCLS recommendations with minimal modifications. Antibiotic was included in Mueller Hinton agar supplemented with 7% horse blood as two-fold dilutions from 128 to 0.008mg/l. A 10[sup 6]cfu/spot inoculum size was applied using a Steer replicator and plates were incubated for 3-5 days in a CO[sub 2] incubator. Resistance was considered when MIC ≥ 8mg/l for metronidazole, when MIC ≥ 1mg/l for amoxicillin and tetracycline. Clarithromycin resistance was considered when MIC ≥ 1mg/l and intermediate when MIC=0.5mg/l. Results: All the strains tested showed MIC< 1mg/l to amoxicillin and to tetracycline. The overall metronidazole resistance was 21.6% and 12.6% for clarithromycin resistance. The number of resistant strains among the total number of strains and the percentage of resistance according to the population and the year of isolation is showed in the table. The increase in resistance to clarithromycin was statistically significant in global data and in strains from the paediatric patients in Madrid and adult patients in Avilés (p<0.01). A statistically significant decrease in the resistance to metronidazole was observed in isolates from Madrid (p<0.05) (isolates from paediatric patients). Conclusions: Resistance to metronidazole and clarithromycin is population dependant. An important...


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