Characteristics of phenotypic antibiotic resistance of Helicobacter pylori and its correlation with genotypic antibiotic resistance: A retrospective study in Ningxia

Helicobacter. 2023 Jun;28(3):e12960. doi: 10.1111/hel.12960. Epub 2023 Apr 11.


Background: Geographic differences exist in the antibiotic resistance patterns of Helicobacter pylori. Personalized treatment regimens based on local or individual resistance data are essential. We evaluated the current status of H. pylori resistance in Ningxia, analyzed resistance-related factors, and assessed the concordance of phenotypic and genotypic resistance.

Methods: Strains were isolated from the gastric mucosa of patients infected with H. pylori in Ningxia and relevant clinical information was collected. Phenotypic antibiotic susceptibility assays (Kirby-Bauer disk diffusion) and antibiotic resistance gene detection (Sanger sequencing) were performed.

Results: We isolated 1955 H. pylori strains. The resistance rates of H. pylori to amoxicillin, levofloxacin, clarithromycin, and metronidazole were 0.9%, 42.4%, 40.4%, and 94.2%, respectively. Only five tetracycline-resistant and one furazolidone-resistant strain were identified. Overall, 3.3% of the strains were sensitive to all six antibiotics. Multidrug-resistant strains accounted for 22.9%, of which less than 20% were from Wuzhong. Strains isolated from women and patients with nonulcerative disease had higher rates of resistance to levofloxacin and clarithromycin. Higher rates of resistance to metronidazole, levofloxacin, and clarithromycin were observed in the older age group than in the younger age group. The kappa coefficients of phenotypic resistance and genotypic resistance for levofloxacin and clarithromycin were 0.830 and 0.809, respectively, whereas the remaining antibiotics showed poor agreement.

Conclusion: H. pylori antibiotic resistance is severe in Ningxia. Therefore, furazolidone, amoxicillin, and tetracycline are better choices for the empirical therapy of H. pylori infection in this region. Host sex, age, and the presence of ulcerative diseases may affect antibiotic resistance of the bacteria. Personalized therapy based on genetic testing for levofloxacin and clarithromycin resistance may be a future direction for the eradication therapy of H. pylori infection in Ningxia.

Keywords: Helicobacter pylori; antibiotic resistance; eradication therapy; gastric disease; genotype; phenotype.

MeSH terms

  • Aged
  • Amoxicillin / therapeutic use
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Clarithromycin / pharmacology
  • Clarithromycin / therapeutic use
  • Drug Resistance, Bacterial
  • Drug Resistance, Microbial
  • Female
  • Furazolidone / therapeutic use
  • Helicobacter Infections* / drug therapy
  • Helicobacter Infections* / microbiology
  • Helicobacter pylori*
  • Humans
  • Levofloxacin / pharmacology
  • Levofloxacin / therapeutic use
  • Metronidazole / pharmacology
  • Metronidazole / therapeutic use
  • Microbial Sensitivity Tests
  • Retrospective Studies
  • Tetracycline / pharmacology
  • Tetracycline / therapeutic use


  • Clarithromycin
  • Metronidazole
  • Levofloxacin
  • Furazolidone
  • Anti-Bacterial Agents
  • Amoxicillin
  • Tetracycline