Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Nov;51(11):1919-1926.
doi: 10.1111/imj.15355.

Helicobacter pylori antimicrobial resistance in Melbourne, Australia. Time to review therapeutic guidelines?

Sadid F Khan  1 , Jasmine C Teng  1 , Jacinta A Holmes  2 , Chandrika Perera  1 , Louise Prendergast  1 , Lynette Waring  1
Affiliations
Review

Helicobacter pylori antimicrobial resistance in Melbourne, Australia. Time to review therapeutic guidelines?

Sadid F Khan et al. Intern Med J. 2021 Nov.

Abstract

Background: Antimicrobial resistance (AMR) in Helicobacter pylori is a global concern. The AMR data to inform the Australian Therapeutic Guidelines are based on data over 20 years old.

Aims: To evaluate the frequency of AMR in H. pylori isolates from gastric biopsy specimens received in our laboratory in Melbourne, Australia. To review the literature on resistance rates in Australia and compare historic data.

Methods: A retrospective, observational study summarising AMR rates in all H. pylori isolates from our laboratory from 2015 to June 2020. Microbiology laboratory in metropolitan Melbourne, Australia, receiving referrals from private hospitals, gastroenterology clinics and endoscopy suites. Population minimum inhibitory concentration distributions and frequency of resistance to clarithromycin, amoxicillin, metronidazole and tetracycline in H. pylori isolates.

Results: Three hundred and eighty-six H. pylori isolates with susceptibility testing data were identified. The frequency of resistance in this cohort was: clarithromycin 89.9%, amoxicillin 23.5%, metronidazole 66.1% and tetracycline 4.4%. Comparison with historical data may suggest increasing AMR rates in Australia. The main limitation is the lack of treatment history to correlate AMR results.

Conclusions: Definitive conclusions from this cohort cannot be made, but trends suggest rising levels of primary H. pylori AMR rates in Australia. This has important implications for empirical treatment decision making and treatment outcomes. Primary H. pylori AMR requires dedicated studies and current Australian therapeutic guideline recommendations may require re-evaluation. We propose considerations for improving the management of H. pylori in Australia. A centralised public health approach to H. pylori AMR surveillance should be established.

Keywords: Australia; Helicobacter pylori; antimicrobial resistance.

PubMed Disclaimer

Comment in

References

    1. Helicobacter pylori infection. In: eTG complete. Melbourne: Therapeutic Guidelines; 2016 (amended 2019). Available from URL: https://www.tg.org.au
    1. Malfertheiner P, Megraud F, O'Morain CA, Gisbert JP et al. Management of H pylori infection - the Maastricht V/Florence Consensus Report. Gut 2017; 66: 6-30.
    1. Chey WD, Leontiadis GI, Howden CW, Moss SF. American college of gastroenterology clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol 2017; 112: 212-38.
    1. Fallone CA, Chiba N, Veldhuyzen van Zanten S, Fischbach L et al. The Toronto Consensus for the treatment of Helicobacter pylori infection in adults. Gastroenterology 2016; 151: 51-69.
    1. IARC Working Group. Schistosomes, live flukes and Helicobacter pylori: IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. IARC Monogr Eval Carcinog Risks Hum 1994; 61: 1-241.

LinkOut - more resources