Work

Helicobacter pylori antimicrobial resistance and CYP2C19 genotypes in a paediatric cohort with initial eradication failure: A study from Henan, China (2019–2024)

Year: 2025

Type: article

Abstract: • High resistance rates to metronidazole and clarithromycin were observed (both >75%), with dual resistance reaching 61.35%, suggesting that empirical treatment is not an option if there has been a previous treatment failure. • From 2019 to 2024, significantly increasing resistance was noted for clarithromycin, metronidazole, and levofloxacin (P<0.05), while furazolidone and tetracycline remained fully susceptible, providing viable alternatives for tailored treatment. • The high prevalence of the CYP2C19 extensive metabolizer genotype (*1/*1) (48.33%) suggests it may be another reason for the failure of empirical H. pylori eradication therapy in children from Henan, China. To investigate the antibiotic resistance profile of Helicobacter pylori ( H. pylori ) strains and the CYP2C19 gene polymorphisms in initial eradication failure children from Henan, China(2019 - 2024). A retrospective cohort study included 207 children diagnosed with H. pylori infection by gastric mucosal histopathology. Participants were categorized by endoscopic findings: normal mucosa (NM), gastritis (GA), or peptic ulcer disease (PUD). Antimicrobial susceptibility testing was performed for amoxicillin (AML), furazolidone (FZD), metronidazole (MTZ), clarithromycin (CLA), tetracycline (TET), and levofloxacin (LEV). CYP2C19 genotyping was conducted via PCR. The annual number of cases increased from 13 in 2019 to 75 in 2024. Abdominal pain (89.4%) and loss of appetite (74.9%) were the most common symptoms. Endoscopic findings were primarily GA (57.0%). Resistance to FZD and TET was undetected (0%), and AML resistance was low (1.45%). High resistance rates were observed for MTZ (75.85%), CLA (75.36%), and LEV (22.22%). Dual MTZ+CLA resistance reached 61.35%, with the highest rate (18.1%) among 13-year-olds. Triple resistance (MTZ+CLA+LEV) was 16.43%. Both single and multidrug resistance increased significantly over time (P<0.05). CYP2C19 genotyping revealed extensive metabolizers (EM, *1/*1) in 48.33%, intermediate metabolizers (IM, *1/*2+*1/*3) in 45.00%, and poor metabolizers (PM, *2/*2+*2/*3) in 6.67%. The high resistance rates to MTZ and CLA, coupled with the CYP2C19 EM phenotype, may contribute to the failure of initial empirical H. pylori eradication in children from Henan, China. Therefore, for retreatment, it is recommended to tailor an individualized regimen based on antimicrobial susceptibility testing and CYP2C19 genotyping results.

Source: Journal of Global Antimicrobial Resistance

DOI: 10.1016/j.jgar.2025.10.024