Helicobacter Pylori Resistance to Antibiotics on the Rise

HealthDay News — Resistance to the antibiotics clarithromycin, metronidazole, and levofloxacin is high among patients with Helicobacter pylori (H. pylori) infection, according to a study published in Clinical Gastroenterology and Hepatology.

Seiji Shiota, MD, PhD, from the Michael E. DeBakey VA Medical Center in Houston, and colleagues assessed the susceptibility of H. pylori to antibiotics among a random sample of 656 patients (90.2% men) from a cohort of 1,559 undergoing esophagogastroduodenoscopy with collection of gastric biopsies in a large metropolitan hospital (2009 through 2013). H. pylori was detected using culture analyses of gastric tissue, and the Epsilometer test was used to determine minimum inhibitory concentrations of antibiotics.

The researchers found that 20.6% of biopsies tested positive for H. pylori (94.8% of these were from males). Only 65 of the 135 positive samples were susceptible to all five antibiotics tested (amoxicillin, clarithromycin, metronidazole, levofloxacin, and tetracycline). 

Antibiotic resistance ranged from 31.3% for levofloxacin, 20.3% for metronidazole, 16.4% for clarithromycin, to 0.8% for tetracycline. No resistance to amoxicillin was detected. Resistance to clarithromycin increased from 9.1% (2009-2010) to 24.2% (2011-2013). In multivariate analysis, prior treatment of H. pylori infection was significantly associated with clarithromycin resistance, and use of fluoroquinolones was significantly associated with levofloxacin resistance.

“The high frequency of resistance to levofloxacin is a new and concerning finding,” the authors write.


1. Shiota S, Reddy R, Alsarraj A., et al. Antibiotic Resistance of Helicobacter pylori Among Male United States Veterans. Clin Gastroenterol Hepatol. 2015;doi.org/10.1016/j.cgh.2015.02.005