853 Helicobacter pylori Resistance to Antibiotics in Europe and Its Relationship to Antibiotic Consumption

Gut (Impact Factor: 14.66). 01/2013; 62(1):34-42. DOI: 10.1136/gutjnl-2012-302254


Resistance to antibiotics is the major cause of treatment failure of Helicobacter pylori infection. A study was conducted to assess prospectively the antibacterial resistance rates of H pylori in Europe and to study the link between outpatient antibiotic use and resistance levels in different countries.

Primary antibiotic resistance rates of H pylori were determined from April 2008 to June 2009 in 18 European countries. Data on yearly and cumulative use over several years of systemic antibacterial agents in ambulatory care for the period 2001-8 were expressed in Defined Daily Doses (DDD) per 1000 inhabitants per day. The fit of models and the degree of ecological association between antibiotic use and resistance data were assessed using generalised linear mixed models.

Of 2204 patients included, H pylori resistance rates for adults were 17.5% for clarithromycin, 14.1% for levofloxacin and 34.9% for metronidazole, and were significantly higher for clarithromycin and levofloxacin in Western/Central and Southern Europe (>20%) than in Northern European countries (<10%). Model fit improved for each additional year of antibiotic use accumulated, but the best fit was obtained for 2005. A significant association was found between outpatient quinolone use and the proportion of levofloxacin resistance (p=0.0013) and between the use of long-acting macrolides only and clarithromycin resistance (p=0.036).

In many countries the high rate of clarithromycin resistance no longer allows its empirical use in standard anti-H pylori regimens. The knowledge of outpatient antibiotic consumption may provide a simple tool to predict the susceptibility of H pylori to quinolones and to macrolides and to adapt the treatment strategies.

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    • "The growing resistance to antibiotics and the shortage of new antimicrobials has been the focus of increasing concern in the past decade. The development and spread of antibiotic resistance in bacteria is a universal threat to both humans and animals and, generally, not preventable (Bush et al. 2011; Megraud et al. 2013). Recently, the World Health Organization (WHO) published an alarming report compiling data from 114 countries named BAntimicrobial Resistance -Global Report on surveillance^ (2014). "
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    Applied Microbiology and Biotechnology 07/2015; 99(18). DOI:10.1007/s00253-015-6795-7 · 3.34 Impact Factor
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    • "Infection caused to Helicobacter pylori is considered the most prevalent cause of gastric diseases such as ulcers, dyspepsia and stomach cancer (Camargo et al., 2014). The drug therapy available for the treatment of diseases caused by this microorganism has limitation such as the high rate of resistance to conventional drugs and inappropriate patient treatment, as presented to numerous side effects (Megraud et al., 2013). In this sense, the use of natural products as an alternative to control this bacterium has shown to be satisfactory, what drives the improvement of investigations of medicinal plants as adjuvant or new antimicrobial drugs (Parreira et al., 2014; Takeuchi et al., 2014). "
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    ABSTRACT: A proton-pump inhibitor (PPI), clarithromycin-based, triple therapy has been the recommended treatment for Helicobacter pylori eradication for the past 15 years. Due to a steady increase in H. pylori resistance to clarithromycin, this triple clarithromycin-based treatment has become progressively less efficacious. Several approaches are available to address this situation: one is to test for clarithromycin resistance so that this triple clarithromycin-based regimen is given only to those who will benefit; a second is to prescribe the drugs sequentially, beginning with amoxicillin and a PPI followed by clarithromycin and metronidazole, again with a PPI or the four drugs prescribed concomitantly; a third alternative is to use bismuth-based quadruple therapy, PPI plus a standardized three-in-one capsule, bismuth subcitrate potassium, metronidazole, and tetracycline (BMT, sold under licence as Pylera®). The advantages of these different approaches are reviewed, including the relevance of BMT three-in-one capsule in clinical practice.
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