• Internal medicine journal · Nov 2021

    Review

    Helicobacter pylori antimicrobial resistance in Melbourne, Australia. Time to review therapeutic guidelines?

    • Sadid F Khan, Jasmine C Teng, Jacinta A Holmes, Chandrika Perera, Louise Prendergast, and Lynette Waring.
    • Department of Microbiology, Melbourne Pathology, Melbourne, Victoria, Australia.
    • Intern Med J. 2021 Nov 1; 51 (11): 1919-1926.

    BackgroundAntimicrobial resistance (AMR) in Helicobacter pylori is a global concern. The AMR data to inform the Australian Therapeutic Guidelines are based on data over 20 years old.AimsTo evaluate the frequency of AMR in H. pylori isolates from gastric biopsy specimens received in our laboratory in Melbourne, Australia. To review the literature on resistance rates in Australia and compare historic data.MethodsA retrospective, observational study summarising AMR rates in all H. pylori isolates from our laboratory from 2015 to June 2020. Microbiology laboratory in metropolitan Melbourne, Australia, receiving referrals from private hospitals, gastroenterology clinics and endoscopy suites. Population minimum inhibitory concentration distributions and frequency of resistance to clarithromycin, amoxicillin, metronidazole and tetracycline in H. pylori isolates.ResultsThree hundred and eighty-six H. pylori isolates with susceptibility testing data were identified. The frequency of resistance in this cohort was: clarithromycin 89.9%, amoxicillin 23.5%, metronidazole 66.1% and tetracycline 4.4%. Comparison with historical data may suggest increasing AMR rates in Australia. The main limitation is the lack of treatment history to correlate AMR results.ConclusionsDefinitive conclusions from this cohort cannot be made, but trends suggest rising levels of primary H. pylori AMR rates in Australia. This has important implications for empirical treatment decision making and treatment outcomes. Primary H. pylori AMR requires dedicated studies and current Australian therapeutic guideline recommendations may require re-evaluation. We propose considerations for improving the management of H. pylori in Australia. A centralised public health approach to H. pylori AMR surveillance should be established.© 2021 Royal Australasian College of Physicians.

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