Helicobacter pylori Clarithromycin Resistance and Treatment Failure Are Common in the USA

Jason Y. Park, Kerry B. Dunbar, Midori Mitui, Christina A. Arnold, Dora M. Lam-Himlin, Mark A. Valasek, Irene Thung, Chinemerem Okwara, Elizabeth Coss, Byron Cryer, Christopher D. Doern

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Background: Helicobacter pylori antibiotic resistance leads to frequent treatment failure. However, the current US prevalence of H. pylori clarithromycin resistance and treatment failure is unknown. Aims: To determine the prevalence of clarithromycin-resistant H. pylori and its impact on treatment failure in the USA. Methods: A multicenter, retrospective, cohort study for clarithromycin-resistant H. pylori was conducted over four academic medical centers in different geographic regions of the USA. Gastric biopsy material, residual from standard clinical pathologic examination, was examined for clarithromycin resistance by DNA sequencing of H. pylori 23S rRNA. Results: One hundred and twenty-four cases of H. pylori gastritis were examined from medical centers in four different geographic regions of the USA. The overall prevalence of clarithromycin resistance was 32.3 % (range 23.1–45.8 %). There was no significant difference in the prevalence of clarithromycin resistance by study site, gender, age, or race/ethnicity. In a subset of 67 patients that had clinical follow-up data, the overall prevalence of clarithromycin resistance was 31.3 %. There was a 2.9-fold increase (p = 0.002) in treatment failure for cases with clarithromycin resistance (57.1 %) compared to wildtype H. pylori (19.6 %). Conclusions: H. pylori clarithromycin resistance in the USA exceeds the estimated 20 % prevalence compatible with successful empiric antibiotic therapy. This resistance resulted in a significant rate of treatment failure in all sites surveyed. Empiric therapy in the USA should be used with caution until there is better regional or local determination of H. pylori antibiotic resistance.

Original languageEnglish (US)
Pages (from-to)2373-2380
Number of pages8
JournalDigestive diseases and sciences
Issue number8
StatePublished - Aug 1 2016


  • 23S rRNA
  • Antibiotic resistance
  • Clarithromycin
  • Helicobacter pylori
  • Treatment failure

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology


Dive into the research topics of 'Helicobacter pylori Clarithromycin Resistance and Treatment Failure Are Common in the USA'. Together they form a unique fingerprint.

Cite this