Metronidazole resistance and virulence factors in Helicobacter pylori as markers for treatment failure in a paediatric population

The eradication rate obtained using the classical triple therapy containing metronidazole, amoxicillin and bismuth citrate, was determined in 57 paediatric patients with digestive disorders, according to the susceptibility to metronidazole of the Helicobacter pylori strains (determined by agar dilution) and the cagA and vacA status (determined by PCR). Eradication was obtained in 38 out of 43 patients (88.3%) infected by H. pylori with metronidazole MIC < or = 2 mg l(-1), in 3 out of 6 patients (50%) when MIC was 4-8 mg l(-1) and in 4 out of 8 patients (50%) when MIC was > 8 mg l(-1). Among patients infected with cagA+ and cagA- strains an eradication rate of 75% (6/8) and 75% (18/24) was found, and 50% (3/6) and 80% (21/26) among vacA s1- and vacA s2-infected subjects (P > 0.05). H. pylori eradication depends on the susceptibility of the strain to metronidazole, being higher in patients infected with susceptible H. pylori. However, according to our data the cagA or vacA status was not an important factor in treatment failure in the eradication of H. pylori.