What can be learnt from the new data about antibiotic resistance? Are there any practical clinical consequences of Helicobacter pylori antibiotic resistance?

Effective treatment regimens are now available for the eradication of Helic obacter pylori, but one of the factors limiting their efficacy is antibioti c resistance. Omeprazole-based triple therapy (omeprazole plus two antibiot ics) can, at present, be considered the treatment of choice for H. pylori i nfection; some of the best results have been achieved by combining omeprazo le with either amoxycillin and clarithromycin or metronidazole and clarithr omycin, However, the potential effectiveness of nitroimidazole derivatives and clarithromycin must be weighed against the possibility that resistance can develop to these agents, Eradication in metronidazole-resistant strains is lower than in sensitive strains, but is still about 75% (versus 97%), H owever, clarithromycin resistance is thought to have more clinical signific ance, reducing the eradication rate of 95% in sensitive strains to 40% in r esistant strains, although the overall importance of clarithromycin resista nce for H, pylori eradication is still likely to be relatively low, Recent data on secondary resistance indicate that the rate is at least 50% for bot h metronidazole and clarithromycin in patients in whom eradication has fail ed. If, in the future, a large number of H. pylori-positive individuals und ergo such treatment, treatment failures may become a major issue, and the p roblem of antibiotic resistance will have to be overcome, Eur J Gastroenter ol Hepatol 11 (suppl 2):S39-S42 (C) 1999 Lippincott Williams & Wilkins.