Low-level primary clarithromycin resistance of Helicobacter pylori in Reunion Island
Abstract
INTRODUCTION: The increasing resistance of Helicobacter pylori to clarithromycin leads to an ongoing adaptation of empirical first-line treatment for H. pylori infections.
PATIENTS AND METHODS: Prospective study (2022-2023) of 364 patients with no previous treatment for H. pylori infection, addressed for gastroduodenal endoscopy to the University Hospital of Reunion Island.
RESULTS: PCR tests (AllplexTMH. pylori & ClariRAssay, Seegene) performed on gastric biopsy samples detected H. pylori DNA in 100 samples (100/364; 27.5 %) and mutations conferring resistance to clarithromycin in 10 of the positive samples (10/100; 10 %). Prevalence of resistance determined by MICs (E-test method) was 41.2 % for metronidazole, 13.2 % for levofloxacin, 8.8 % for clarithromycin. No resistance was detected for tetracycline, rifampicin, and amoxicillin.
CONCLUSION: The prevalence of primary clarithromycin-resistant H. pylori in Reunion Island is below 15 %. Recommendation for the standard clarithromycin-based triple therapy as a first-line treatment can thus be maintained, even though antimicrobial susceptibility testing seems preferable.
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 364 participants or records.
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