Implications of antibiotic resistance in the management of Helicobacter pylori infection: Canadian Helicobacter Study Group

Eradication of Helicobacter pylori from the gastric and duodenal mucosa is an important clinical goal in the treatment of infected patients with pepti c ulcer disease and other H pylori-associated conditions. Although several oral drug combination regimens ate associated with eradication rates of app roximately 85% in controlled trials, the success rate in patients infected with a resistant strain of H pylori is closer to 75%. Resistance to metroni dazole and clarithromycin, which are common components of combination treat ment regimens, is of greatest concern. Reported rates of H pylori resistanc e to various antibiotics vary considerably. In Canada, the data documenting H pylori susceptibility are limited but suggest that resistance to these a ntibiotics varies geographically and within specific treatment groups. Alth ough susceptibility testing is not a prerequisite for initial treatment of individual patients infected with H pylori, formal efforts to identify and monitor both the causes and prevalence of antibiotic resistance across Cana da are a much needed step in the ongoing management of this important infec tion. Recommended treatment regimens may be useful, even for treating appar ently resistant H pylori strains. However, it is important to understand th e mechanisms of the development of resistant strains to manage patients wit h treatment failure better.