Biofilm Formation and Antibiotic Resistance Phenotype of Helicobacter pylori Clinical Isolates

Kartika Afrida Fauzia, Muhammad Miftahussurur, Ari Fahrial Syam, Langgeng Agung Waskito, Dalla Doohan, Yudith Annisa Ayu Rezkitha, Takashi Matsumoto, Vo Phuoc Tuan, Junko Akada, Hideo Yonezawa, Shigeru Kamiya, Yoshio Yamaoka

Research output: Contribution to journalArticlepeer-review

28 Citations (Scopus)


We evaluated biofilm formation of clinical Helicobacter pylori isolates from Indonesia and its relation to antibiotic resistance. We determined the minimum inhibition concentration (MIC) of amoxicillin, clarithromycin, levofloxacin, metronidazole and tetracycline by the Etest to measure the planktonic susceptibility of 101 H. pylori strains. Biofilms were quantified by the crystal violet method. The minimum biofilm eradication concentration (MBEC) was obtained by measuring the survival of bacteria in a biofilm after exposure to antibiotics. The majority of the strains formed a biofilm (93.1% (94/101)), including weak (75.5%) and strong (24.5%) biofilm-formers. Planktonic resistant and sensitive strains produced relatively equal amounts of biofilms. The resistance proportion, shown by the MBEC measurement, was higher in the strong biofilm group for all antibiotics compared to the weak biofilm group, especially for clarithromycin (p = 0.002). Several cases showed sensitivity by the MIC measurement, but resistance according to the MBEC measurements (amoxicillin, 47.6%; tetracycline, 57.1%; clarithromycin, 19.0%; levofloxacin, 38.1%; and metronidazole 38.1%). Thus, biofilm formation may increase the survival of H. pylori and its resistance to antibiotics. Biofilm-related antibiotic resistance should be evaluated with antibiotic susceptibility.

Original languageEnglish
Article number473
Issue number8
Publication statusPublished - 24 Jul 2020


  • amoxicillin
  • antibiotic resistance
  • biofilm formation
  • biofilm-specific resistance
  • clarithromycin
  • Helicobacter pylori
  • levofloxacin
  • metronidazole
  • tetracycline


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