An editorial (by Ben Gold -congratulations!) helps sort out the potential advantages of gene based testing for Helicobacter pylori in a commentary on a recent publication (JPGN 2014; 59: 6-9).
In the study, the authors used formalin=fixed biopsies in 38 H pylori--infected gastric biopsies. These specimens were examined for 23S rRNA mutations associated with resistance to clarithromycin. Overall, the authors (from Dallas, TX) noted H pylori in 4.5% of their biopsies. The majority of these children, treated between 2010-2012, were given clarithromycin, amoxicillin, and a proton pump inhibitor (n=25). Due to clarithromycin resistance, this is no longer considered a first-line treatment in the absence of clarithromycin susceptibility testing according to NASPGHAN guidelines (published in 2011).
The authors noted a cure rate of 62.5%, likely due to the use of clarithromycin-based triple therapy. In addition, Dr. Gold notes that the authors identified a very high rate of clarithromycin resistance (50%): “greater than that reported by any of the previously published national surveys or single-center studies in the United States, Europe, or Japan.”
Take-home point from Dr. Gold: “Because the common mutations responsible for H pylori resistance to the other major antimicrobials used for eradication…have been described, the assay developed by Mittui et al could be modified to include a panel of antibiotics…to optimize therapy.”
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