Resistance of Helicobacter Pylori to Antibiotics in Children
Condition: Abdominal Pain; Children; Bacterial Infection Due to Helicobacter Pylori (H. Pylori); Antibiotic Resistant Strain
MeSH terms: Bacterial Infections; Abdominal Pain
Study type: Observational

Summary: 
      Helicobacter Pylori (HP) is one of the most common pathogens in humans. This infection can
      present in children with abdominal pain, vomiting and iron deficiency. The treatment is
      usually empiric and includes antibiotic treatment usually Amoxycillin and Clarithromycin or
      Metronidazole. Between 40 to 70 % of the pathogens are resistant to those drugs, and it is
      important to characterize the specific sensitivity of the pathogens in any specific area and
      in pediatric population. The aims of this study is to assess the sensitivity of HP in
      pediatric population in Northern Israel.
    

Detailed description: 
      The aim of our prospective study is to investigate the rate of H pylori resistant strains to
      antibiotic treatment including Amoxicillin, Clarithromycin, Metronidazole, Tetracycline and
      Quinolones in pediatric population in Ha-Emek medical center, Afula. The second aim was to
      determine if in vitro resistance is being reflected in vivo too.

      Should the investigators find high rates of H pylori resistance to Clarithromycin, the
      investigators will have to reconsider the recommendation to use Clarithromycin as the first
      line treatment for H pylori.

      Our research group will conclude 100 children in the ages of 1-18 years, evaluated for
      recurrent abdominal pain, iron deficiency anemia, failure to thrive by an upper endoscopy,
      biopsy specimens taken for a rapid urease test, for histology, for culture and for antibiotic
      susceptibility testing.

      Biopsy specimens for histology will be fixed in formalin, embedded in paraffin and sectioned
      and stained with hematoxylin and eosin.

      The microbiological workup will include an imprint of the biopsy on a slide followed by a
      gram stain for the purpose of demonstrating H. pylori in situ. Further the biopsies will be
      streaked out on chocolate agar, Sheep blood agar and H. pylori selective agar supplemented
      with Polymixin to suppress possible contaminants.

      4 days of incubation in a micro aerophilic atmosphere will follow . Susceptibility testing of
      H pylori will be performed with E test on Mueller Hinton agar supplemented with defibrinated
      sheep blood using a MacFalrland 3.0 density of a bacterial suspension. Reading the
      susceptibility will take place following 72 hours of incubation in a micro aerophilic
      atmosphere.
    

Intervention name(s): Helicobacter Pylori Culture
Intervention type(s): Other
Intervention description(s): Biopsy specimens for histology will be fixed in formalin, embedded in paraffin and sectioned and stained with hematoxylin and eosin.
The microbiological workup will include an imprint of the biopsy on a slide followed by a gram stain for the purpose of demonstrating H. pylori in situ. Further the biopsies will be streaked out on chocolate agar, Sheep blood agar and H. pylori selective agar supplemented with Polymixin to suppress possible contaminants.
4 days of incubation in a micro aerophilic atmosphere will follow . Susceptibility testing of H pylori will be performed with E test on Mueller Hinton agar supplemented with defibrinated sheep blood using a MacFalrland 3.0 density of a bacterial suspension. Reading the susceptibility will take place following 72 hours of incubation in a micro aerophilic atmosphere.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Our research group will conclude 100 children in the ages of 1-18 years, evaluated for
        recurrent abdominal pain, iron deficiency anemia, failure to thrive by an upper endoscopy,
        biopsy specimens taken for a rapid urease test, for histology, for culture and for
        antibiotic susceptibility testing.