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NICE guidance on treating Helicobacter pylori infection in patients with dyspepsia could lead to a surge in antibiotic resistance, senior Government advisers warn.

Experts in microbial resistance called for a 'rethink' in the approach to treating

H. pylori after the study found 59 per cent of isolates were resistant to metronidazole.

NICE advises that GPs use two antibiotics from metronidazole, clarithromycin, amoxicillin and tetracycline alongside an acid suppressor.

The Health Protection Agency researchers found patients born outside the UK were particularly likely to carry resistant bacteria. They urged a targeted approach to treatment taking into account local resistance levels.

Study leader Dr Robert Owen, head of the HPA's campylobacter and helicobacter reference unit, said: 'With the proposals for a test and treat strategy, there is a risk of future increases in antibiotic resistance if empirical treatment is used.

'It is important to monitor resistance to have accurate

information on local rates,

to guide selection of specific and appropriate treatments.'

Dr Douglas Fleming, member of the Government's Standing Advisory Committee on Antimicrobial Resistance and director of the RCGP's Birmingham research unit, said: 'Levels of resistance as high as 59 per cent really do call for a rethink of management strategy. The paper has shown quite clearly that resistance to metronidazole is a problem and I endorse the view that it needs to be monitored on a continuing basis.'

Dr Richard Stevens, chair of the primary care society for gastroenterology, said: 'Ideally there should be known local patterns of resistance. There needs to be tailoring of treatment to the patient, not rigid adherence to NICE or any other algorithm.'

Researchers evaluated susceptibility to antibiotics in two London clinics and found rates of metronidazole resistance ranging from 40 per cent in patients born in the UK to 69 per cent in those born outside.

The study, in this month's Journal of Medical Microbiology, found 11 per cent of bacterial isolates were resistant to clarithromycin, but all were sensitive to amoxicillin and tetracycline.

By Cato Pedder

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