Digestive Diseases and Sciences

, Volume 61, Issue 8, pp 2373–2380 | Cite as

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

  • Jason Y. ParkEmail author
  • 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
Original Article



Helicobacter pylori antibiotic resistance leads to frequent treatment failure. However, the current US prevalence of H. pylori clarithromycin resistance and treatment failure is unknown.


To determine the prevalence of clarithromycin-resistant H. pylori and its impact on treatment failure in the USA.


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.


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 %).


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.


Helicobacter pylori Clarithromycin 23S rRNA Antibiotic resistance Treatment failure 



We thank David Y. Graham, MD, Baylor College of Medicine, for assistance in the development of the clarithromycin resistance test (23S rRNA).

Compliance with ethical standards

Conflict of interest

The authors declare no personal or funding interests.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Jason Y. Park
    • 1
    • 2
    • 3
    Email author
  • Kerry B. Dunbar
    • 4
    • 5
    • 6
  • Midori Mitui
    • 3
  • Christina A. Arnold
    • 7
  • Dora M. Lam-Himlin
    • 8
  • Mark A. Valasek
    • 9
  • Irene Thung
    • 9
  • Chinemerem Okwara
    • 6
  • Elizabeth Coss
    • 5
    • 6
    • 11
  • Byron Cryer
    • 4
    • 5
    • 6
  • Christopher D. Doern
    • 10
  1. 1.Department of PathologyUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Eugene McDermott Center for Human Growth and DevelopmentUniversity of Texas Southwestern Medical CenterDallasUSA
  3. 3.Department of PathologyChildren’s Health DallasDallasUSA
  4. 4.Medical ServiceDallas Veterans Affairs Medical CenterDallasUSA
  5. 5.Division of Gastroenterology and HepatologyUniversity of Texas Southwestern Medical CenterDallasUSA
  6. 6.Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasUSA
  7. 7.Department of PathologyOhio State University Wexner Medical CenterColumbusUSA
  8. 8.Department of Pathology and Lab MedicineMayo Clinic, ArizonaScottsdaleUSA
  9. 9.Division of Anatomic Pathology, Department of PathologyUniversity of California, San DiegoSan DiegoUSA
  10. 10.Department of PathologyVirginia Commonwealth University Health SystemRichmondUSA
  11. 11.Texas Digestive Disease ConsultantsDallasUSA

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