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Cited by 14Helicobacter pylori-related gastroenterology studiesHepatitis C virus researchSalmonella and Campylobacter epidemiology

Antibiotic resistance, heteroresistance, and eradication success of Helicobacter pylori infection in children

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Kotilea, Kallirroi, Iliadis, Eleni, Nguyen, Julie, Salame, Assad, Mahler, Tania, Miendje Deyi, Veronique Yvette, Bontems, Patrick·2023·Helicobacter
DOI 10.1111/hel.13006
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Abstract

Background: Antibiotic resistance is a well‐known factor of Helicobacter pylori eradication failure. Heteroresistance indicates the coexistence of resistant and susceptible strains and might lead to underestimating antimicrobial resistance. This study aims to evaluate the susceptibility profile, the frequency of heteroresistance of H. pylori strains, and their effect on eradication success in a pediatric population. Materials and Methods: Children aged 2–17 years who underwent an upper gastrointestinal endoscopy from 2011 to 2019 with positive H. pylori status were included. Susceptibility was measured by disk diffusion and E‐test. The difference in susceptibility profiles between isolates from the antrum and the corpus was used to detect heteroresistance. For those who received eradication treatment, we evaluated eradication rate and factors affecting treatment success. Results: Inclusion criteria were met by 565 children. Strains susceptible to all antibiotics were detected in 64.2%. Primary resistance rates for clarithromycin (CLA), metronidazole (MET), levofloxacin (LEV), tetracyclin (TET), and amoxicillin (AMO) were 11%, 22.9%, 6.9%, 0.4%, and 0% and secondary resistance rates were 20.4%, 29.4%, 9.3%, 0%, and 0%. Heteroresistance was present in untreated children in 2%, 7.1%, 0.7%, 0.7%, and 0% for CLA, MET, LEV, TET, and AMO. First‐line eradication rates were 78.5% in intention‐to‐treat (ITT), 88.3% in full‐analysis‐set (FAS), and 94.1% in per‐protocol (PP). Factors affecting eradication success were the duration of treatment when the triple‐tailored treatment was used, the number of daily doses of amoxicillin administered, and the patient's adherence to treatment. Conclusions: This study shows the presence of relatively low primary resistance rates for H. pylori isolates but demonstrates the presence of heteroresistance in our population. Routine biopsies from the antrum and corpus must be considered for susceptibility testing to allow tailored treatments and increase eradication rates. Treatment success is affected by treatment choice, correct dosing of medications, and adherence. All these factors should be considered when evaluating the efficacy of an eradication regimen.

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  • For diagnosed fungal infections, antifungal heteroresistance may lead to persistent infections that require longer or more aggressive treatment regimens.

    “For diagnosed fungal infections, it may lead to persistent infections that require longer or more aggressive treatment regimens [27,28,29,30].”

    From Insight into the Mechanisms and Clinical Relevance of Antifungal Heteroresistance (2025) · cites this paper as [27]

    The Introduction says heteroresistance may influence treatment success in children with bacterial H. pylori infection. The Discussion links possible undetected heteroresistance to difficulty eradicating resistant strains, but the paper does not address fungal infections, antifungal heteroresistance, or a resulting need for longer or more aggressive treatment. (LLM, conf=0.83)

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Research works printed but not linked: 1

  1. Miendje Deyi VY, Hammouti A, Fosseprez G, De Giorgi C, Debyttere A, Hallin M. Comparative evaluation of Helicobacter pylori suscep- tibility testing methods to optimize routine analysis. Microb Health Dis. 2021;3:e612.

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Authors
Kotilea, K., Iliadis, E., Nguyen, J., Salame, A., Mahler, T., Miendje Deyi, V. Y., & Bontems, P.
Affiliations
  • Université Libre de Bruxelles (BE)
  • Microbiology Department, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB‐ULB) Université Libre de Bruxelles Brussels Belgium
Corresponding author
Kotilea, Kallirroi
ORCID
Venue
Helicobacter
Publisher
Wiley
Published
2023-07-04
Volume
28
Issue
5
Pages
e13006-e13006
ISSN
  • 1083-4389 (ISSN-L)
  • 1523-5378
DOI
10.1111/hel.13006
OpenAlex
W4383058957
Cited by
14
References
32
Citations by year
2026: 1 · 2025: 4 · 2024: 8 · 2023: 1
FWCI
3.76
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Helicobacter (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Helicobacter pylori-related gastroenterology studies
  • Health Sciences › Medicine › Hepatology › Hepatitis C virus research
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Salmonella and Campylobacter epidemiology
Keywords
antibiotic resistance, heteroresistance, eradication therapy, pediatric patients, clarithromycin resistance, metronidazole resistance, levofloxacin resistance, amoxicillin, triple therapy, medication adherence, susceptibility testing, eradication failure
MeSH terms
Amoxicillin, Anti-Bacterial Agents, Child, Drug Therapy, Combination, Humans, Metronidazole, Tetracycline, Helicobacter pylori, Helicobacter Infections, Clarithromycin, Drug Resistance, Bacterial, Levofloxacin

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