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Risk Factors for Helicobacter pylori Resistance
Thomas W. Hennessy, MD, MPH;
Brian J. McMahon, MD; and
Jay C. Butler, MD
1 June 2004 | Volume 140 Issue 11 | Page 931
IN RESPONSE:
We agree that the SHARP study (1) was useful for establishing the prevalence of antimicrobial resistance among H. pylori in the United States. However, the SHARP analysis did not include the most important determinant of antimicrobial resistance: an individual's antimicrobial use. Therefore, we believe the factors associated with antimicrobial-resistant H. pylori in the SHARP study are useful for hypothesis generation, but their value for clinical decision making is highly suspect. The factors cited by Drs. Seow and Chew are likely to be markers for patients with higher antimicrobial use. For example, the higher frequency of metronidazole-resistant H. pylori infection among women is explained in our study by higher rates of metronidazole use. In addition, it is unclear how to apply Drs. Seow and Chew's recommendation of using multiple risk factors to assess the risk for antimicrobial-resistant infection when those risk factors are contradictory, as would be the case for a person of low-risk ethnicity living in a high-risk geographic region. We believe that until antimicrobial susceptibility testing becomes more readily available for clinical use, past antimicrobial use will remain the simplest and most reliable means of assessing the risk for metronidazole- or clarithromycin-resistant H. pylori.
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Author and Article Information
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From Centers for Disease Control and Prevention, Anchorage, AK 99508.
1. Meyer JM, Silliman NP, Wang W, Siepman NY, Sugg JE, Morris D, et al. Risk factors for Helicobacter pylori resistance in the United States: the surveillance of H. pylori antimicrobial resistance partnership (SHARP) study, 1993-1999. Ann Intern Med. 2002;136:13-24. [PMID: 11777360].[Abstract/Free Full Text]
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Risk Factors for Helicobacter pylori Resistance in the United States: The Surveillance of H. pylori Antimicrobial Resistance Partnership (SHARP) Study, 1993–1999
Joette M. Meyer, Nancy P. Silliman, Wenjin Wang, Nancy Y. Siepman, Jennifer E. Sugg, David Morris, Jie Zhang, Helen Bhattacharyya, Eileen C. King, AND Robert J. Hopkins
- Annals 2002 136: 13-24.
[ABSTRACT][SUMMARY][Full Text]
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