H. pylori clarithromycin resistance above the Maastricht criteria in Hungary

Resistance to clarithromycin is proved to be the major cause behind Helicobacter pylori eradication failures. Resistance rate shows an increasing trend especially in Eastern, Southern and Central Europe. In order to test clarithromycin resistance rate in Hungary three University Pathology Departments (1st and 2nd Institutes of Pathology, Semmelweis University, Budapest and the Pathology Department of University of Szeged) carried out fluorescent in situ hybridization (FISH) based clarithromycin resistance assays on altogether 4714 non-eradicated and 403 unsuccessfully eradicated patients between 2003–2007. Both primary and secondary resistance rates showed marked increase from 12.8% and 47,9% in 2002 to 18,82% and 70% in 2007, respectively. Our data represent a national average with probably considerable regional/local differences. As the Maastrich III Consensus report (2005) recommends resistance testing before treatment if primary resistance to clarithromycin is greater than 15–20%, the introduction of pre-therapy antibiotic susceptibility testing of H. pylori infected patients by the fast and robust FISH method seems to be reasonable in Hungary. However, final decision-making on a mandatory introduction of testing all H. pylori positive patients should be based on further comprehensive surveys.