E-test versus agar dilution for antibiotic susceptibility testing of Helicobacter pylori: A comparison study

Muhammad Miftahussurur, Kartika Afrida Fauzia, Iswan Abbas Nusi, Poernomo Boedi Setiawan, Ari Fahrial Syam, Langgeng Agung Waskito, Dalla Doohan, Neneng Ratnasari, Ali Khomsan, I. Ketut Adnyana, Junko Akada, Yoshio Yamaoka

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37 Citations (Scopus)


Objective: For evaluating the antibiotic resistance of Helicobacter pylori, the agar dilution method is the gold standard; however, using this method in daily practice is laborious. E-test has been proposed to be an uncomplicated method. This study was aimed at validating the E-test and detecting the presence of any bias between the agar dilution method and E-test. Results: The agar dilution method and E-test were performed using five antibiotics for 72 strains of H. pylori obtained from clinical patients in Indonesia. The E-test's results showed a higher prevalence of resistance to all the antibiotics tested but the difference was not significant. Results showed high essential agreement (> 90.0%) for all the antibiotics, but only 84.7% for metronidazole. The agreement for MIC value was acceptable for levofloxacin, clarithromycin, and metronidazole. For amoxicillin, it showed only fair agreement (0.25) by the Kappa analysis and significant difference by Passing-Bablok regression. Even though some discrepancies were found, the E-test has an acceptable agreement for levofloxacin, metronidazole, tetracycline, and clarithromycin but further confirmation may be necessary for amoxicillin.

Original languageEnglish
Article number22
JournalBMC Research Notes
Issue number1
Publication statusPublished - 10 Jan 2020


  • Agar dilution
  • Antibiotic susceptibility test
  • E-test
  • Helicobacter pylori


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