Helicobacter pylori antimicrobial resistance: Test, then Treat

Review by Prof. Humphrey O'Connor (Ireland)

Study Summary 

Increasing antimicrobial resistance has made H. pylori infection more difficult to eradicate and antibiotic susceptibility testing (AST) remains rare in clinical practice. A recent study from Munich assessed the accuracy of culture-independent gastric aspirate-based genotypic-AST with culture-dependent gastric biopsy-based phenotypic-AST. Of 461 consecutive patients, 178 (40.4%) tested positive for H. pylori, detected by gastric juice analysis for ammonium during endoscopy (results in 60 seconds). Resistance rates by phenotypic-based AST (results in 8-12 days) were 15.1% for clarithromycin and 18.4% for levofloxacin. Genotypic-AST (results in 1 day) showed a high level of agreement with phenotypic-AST with diagnostic accuracy of 97% and 95% respectively.

Commentary 

Genotypic-AST from gastric aspirates gives highly accurate and rapid detection of H. pylori resistance to clarithromycin and levofloxacin and presents a valid alternative to culture-based AST. Resistance to other antibiotics was not included in the study but the system could be expanded to do so, albeit at additional cost. At a broader level, worldwide uptake of genotypic AST for H. pylori is likely to hinge on a tradeoff between accuracy, ease of use, and cost effectiveness. Other important issues in this rapidly evolving field are efforts to develop rapid on-site genotypic analysis, and alternative methods to optimize sample collection, mindful of patients not undergoing endoscopy.

Citation

Vasapolli R, Ailloud F, Spiebberger b, Malfertheiner P, Suerbaum S, Schulz C. Real-time assessment of H.pylori  infection to guide molecular antibiotic resistance testing : A combined endoscopy- gastric juice analysis approach. Alimentary Pharmacology & Therapeutics 2025; 61:465-471

https://doi.org/10.1111/apt.18378

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