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This is an introduction to the Gut tutorial “Helicobacter pylori and antibiotic resistance” hosted on BMJ Learning—the best available learning website for medical professionals from the BMJ Group.
H pylori is a Gram-negative flagellated spiral bacteria. Infection with H pylori is mainly acquired in childhood. About 15% of infected people will develop a peptic ulcer and 1% will develop gastric cancer during their lifetime. Resistance to antibiotics is important as it leads to treatment failure. The prevalence of H pylori resistance to clarithromycin is <5% for adults in northern Europe, but as high as 20% in southern Europe. Resistance to clarithromycin is caused by previous consumption of macrolides. Resistance is higher in children because prescriptions of these drugs, particularly for children, have increased during the past decade, mainly for respiratory tract infections. The prevalence of H pylori resistance to metronidazole varies from 20–40% in Europe and the USA to 50–80% in developing countries. Metronidazole is used extensively for treating parasitic diseases in tropical countries, which is probably why there is more resistance there. For patients needing a second course of eradication treatment, a regimen should be chosen that does not include antibiotics given previously. Once you successfully eradicate H pylori, adult reinfection rates are low at <1% a year.
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