Dual Clarithromycin and Metronidazole Resistance is the Main Cause of Failure in Ultimate Helicobacter pylori Eradication.

Background/aim Antimicrobial resistance significantly affects the cure rate of Helicobacter pylori (H. pylori) eradication. We evaluated the risk factor of failure in ultimate H. pylori eradication and assessed the efficacy of current regimens to overcome antibiotic resistance. Methods Patients with H. pylori infection were prospectively enrolled in a single center. They were classified into three groups according to the previous history of H. pylori eradication, and antibiotic susceptibility was evaluated by culture and minimum inhibitory concentrations (MIC). Results 97 patients successfully H. pylori cultured and 81 (83.5%), 7 (7.2%), and 9 (9.3%) were classified into primary resistance, 1st eradication failure, and 2nd or more eradication failure groups; the resistance to clarithromycin (CLA), metronidazole (MET), and levofloxacin (LEV) increased in the 1st eradication failure (85.7%, 57.1%, and 42.9%) and 2nd and more eradication failure (88.9%, 88.9%, and 55.6%) groups. The prevalence of MDR was 21.0% (17/81), 57.1% (4/7), and 88.9% (8/9) in the primary, 1st eradication failure, and 2nd or more eradication failure groups, respectively. In multivariate analysis, dual CLA/MET resistance (CLA/MET-R) (OR=31.432, 95% CI: 3.094-319.266, P=0.004) were independent risk factors for ultimate H. pylori eradication failure. In patients with dual CLA/MET-R, the eradication ratio of concomitant therapy was 57.1% (4/7), whereas that of bismuth-containing quadruple therapy was 27.3% (3/11) (P=0.350). Conclusions Dual CLA/MET-R was the main cause of failure in ultimate H. pylori eradication, and 7 days- bismuth quadruple or concomitant regimen would not be suitable for H. pylori eradication in dual CLA/MET-R group.