{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:57:39Z","timestamp":1789498659684,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T00:00:00Z","timestamp":1688428800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Helicobacter"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Antibiotic resistance is a well\u2010known factor of<jats:italic>Helicobacter pylori<\/jats:italic>eradication failure. Heteroresistance indicates the coexistence of resistant and susceptible strains and might lead to underestimating antimicrobial resistance. This study aims to evaluate the susceptibility profile, the frequency of heteroresistance of<jats:italic>H. pylori<\/jats:italic>strains, and their effect on eradication success in a pediatric population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Children aged 2\u201317\u2009years who underwent an upper gastrointestinal endoscopy from 2011 to 2019 with positive<jats:italic>H. pylori<\/jats:italic>status were included. Susceptibility was measured by disk diffusion and E\u2010test. The difference in susceptibility profiles between isolates from the antrum and the corpus was used to detect heteroresistance. For those who received eradication treatment, we evaluated eradication rate and factors affecting treatment success.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Inclusion criteria were met by 565 children. Strains susceptible to all antibiotics were detected in 64.2%. Primary resistance rates for clarithromycin (CLA), metronidazole (MET), levofloxacin (LEV), tetracyclin (TET), and amoxicillin (AMO) were 11%, 22.9%, 6.9%, 0.4%, and 0% and secondary resistance rates were 20.4%, 29.4%, 9.3%, 0%, and 0%. Heteroresistance was present in untreated children in 2%, 7.1%, 0.7%, 0.7%, and 0% for CLA, MET, LEV, TET, and AMO. First\u2010line eradication rates were 78.5% in intention\u2010to\u2010treat (ITT), 88.3% in full\u2010analysis\u2010set (FAS), and 94.1% in per\u2010protocol (PP). Factors affecting eradication success were the duration of treatment when the triple\u2010tailored treatment was used, the number of daily doses of amoxicillin administered, and the patient's adherence to treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study shows the presence of relatively low primary resistance rates for<jats:italic>H. pylori<\/jats:italic>isolates but demonstrates the presence of heteroresistance in our population. Routine biopsies from the antrum and corpus must be considered for susceptibility testing to allow tailored treatments and increase eradication rates. Treatment success is affected by treatment choice, correct dosing of medications, and adherence. All these factors should be considered when evaluating the efficacy of an eradication regimen.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hel.13006","type":"journal-article","created":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T15:51:18Z","timestamp":1688485878000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Antibiotic resistance, heteroresistance, and eradication success of<i>Helicobacter pylori<\/i>infection in children"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0411-0680","authenticated-orcid":false,"given":"Kallirroi","family":"Kotilea","sequence":"first","affiliation":[{"name":"Pediatric Gastroenterology, H\u00f4pital Universitaire des Enfants Reine Fabiola Universit\u00e9 Libre de Bruxelles Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Iliadis","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology, H\u00f4pital Universitaire des Enfants Reine Fabiola Universit\u00e9 Libre de Bruxelles Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology, H\u00f4pital Universitaire des Enfants Reine Fabiola Universit\u00e9 Libre de Bruxelles Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assad","family":"Salame","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology, H\u00f4pital Universitaire des Enfants Reine Fabiola Universit\u00e9 Libre de Bruxelles Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Mahler","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology, H\u00f4pital Universitaire des Enfants Reine Fabiola Universit\u00e9 Libre de Bruxelles Brussels 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