Antimicrobial susceptibility of Helicobacter pylori strains isolated from children in Israel

Objectives: Helicobacter pylori is a bacterial pathogen causing inflammation of the gastric mucosa that may lead to peptic ulcer, perforation or malignancy. Children are at risk of contracting H. pylori and developing subsequent morbidity. Diagnosis and management in children are difficult and merit a different approach compared with adults. This study aimed to describe the antimicrobial resistance rates of H. pylori to amoxicillin, tetracycline, clarithromycin, metronidazole, levofloxacin and rifampicin. Methods: Biopsies (n = 154) collected during endoscopic examinations were cultivated for 10 days using a growth medium selective for H. pylori, of which 89 were H. pylori-positive. Antimicrobial resistance of the strains was assessed by Etest to establish minimum inhibitory concentrations (MICs) according to British Society for Antimicrobial Chemotherapy guidelines. Results: Resistance rates were most notable for amoxicillin and clarithromycin at 12% and 35% with MICs of 0.74 μg/mL and 2.51 μg/mL, respectively. Resistance rates to tetracycline and levofloxacin were 8% and 2% with MICs of 2.57 μg/mL and 2.0 μg/mL, respectively. Resistance rates to rifampicin and metronidazole were 3% and 8% with MICs of 2.0 μg/mL and 9.71 μg/mL, respectively. Conclusion: Current rising antibiotic resistance rates for H. pylori are of concern. Performance of culture enables determination of the susceptibility profile, which may lead to a better choice of, and perhaps narrower spectrum, antibiotic agent. In light of these findings, we suggest that optimising the choice of antibiotic agent in children with H. pylori infection remains a challenge for clinicians and thus requires further investigation in randomised clinical trials.