Implications of Antibiotic Resistance in the Management ofHelicobacter pyloriInfection: CanadianHelicobacterStudy Group

Abstract

Eradication ofHelicobacter pylorifrom the gastric and duodenal mucosa is an important clinical goal in the treatment of infected patients with peptic ulcer disease and otherH pylori-associated conditions. Although several oral drug combination regimens are associated with eradication rates of approximately 85% in controlled trials, the success rate in patients infected with a resistant strain ofH pyloriis closer to 75%. Resistance to metronidazole and clarithromycin, which are common components of combination treatment regimens, is of greatest concern. Reported rates ofH pyloriresistance to various antibiotics vary considerably. In Canada, the data documentingH pylorisusceptibility are limited but suggest that resistance to these antibiotics varies geographically and within specific treatment groups. Although susceptibility testing is not a prerequisite for initial treatment of individual patients infected withH pylori, formal efforts to identify and monitor both the causes and prevalence of antibiotic resistance across Canada are a much needed step in the ongoing management of this important infection. Recommended treatment regimens may be useful, even for treating apparently resistantH pyloristrains. However, it is important to understand the mechanisms of the development of resistant strains to manage patients with treatment failure better.