Arch Dis Child 2001 Volume 84 No 5

H pylori—which antibiotic?

Medical students learn that before prescribing an antibiotic it's a good idea to know which one the offending organism doesn't like. If the facilities are available, resistance and sensitivity testing provides a gold standard. Yet the regimes advised for treatingHelicobacter pylori do not mention such sophistication. Street and others from Parma correct this omission in this month's ADC (page 419). They treated 75 H pylori infected children with a standard antibiotic combination and the next 75 with a combination based on the results of susceptibility tests. Six months later, the authors tested for eradication by endoscopic biopsy histology and rapid urease. When treated “blindly” the organism was eradicated in 83%, rising to 98% after treatment based on susceptibility. The one failure in the latter group was a patient receiving corticosteroids for Crohn's disease.

The authors point out that the cost of testing is offset by savings from fewer repeat treatment …