Antibiotic resistance problems with Helicobacter pylori.

Helicobacter pylori is very susceptible in vitro to most antibiotics, but when they are used in the clinical setting, eradication of the bacteria from the gastric mucosa is not obtained. Dual or triple therapy including two of the following antibiotics: amoxicillin, tetracycline, metronidazole or clarithromycin, plus a proton pump inhibitor, bismuth salt or ranitidine bismuth citrate is the most frequently used. Various in vitro susceptibility methods have been used: disk diffusion, agar dilution and Epsilometer test (E-test). Metronidazole resistance among H. pylori strains is now found worldwide, and resistance rates vary according to the population studied. It is higher in developing than in developed countries and it could reach 80-90% in Africa. The prevalence on clarithromycin resistance is much lower, usually below 10%, although very high values are reported in Peru. Infection with metronidazole- or clarithromycin-resistant H. pylori strains is correlated with treatment failure when using regimens including these antibiotics.