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.

22 Reads
    • "However, this combination seems to have lost efficacy over the last decade [Malfertheiner et al. 2012], mostly due to clarithromycin resistance [Neri et al. 2003]. The overall clarithromycin resistance rate in Europe increased from 9% in 1998 to 17.6% in 2008 [Malfertheiner et al. 2012], and primary resistances are above 20% in many European countries [Megraud et al. 2013]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Susceptibility-guided therapies (SGTs) have been proposed as preferable to empirical rescue treatments after two treatment failures. The aim of this study was to perform a systematic review and meta-analysis evaluating the effectiveness and efficacy of SGT as third-line therapy.
    No preview · Article · Dec 2015 · Therapeutic Advances in Gastroenterology
    • "Although agar dilution method (the only CLSI approved Helicobacter pylori susceptibility testing method) and E test are preferred methods for testing H. pylori susceptibility to antibiotics, modified disk diffusion method (MDDM) is an alternative option for low-resource laboratories (Chisholm and Owen, 2009; Megraud et al., 2013; Yu et al., 2011). MDDM is less expensive compared with the E test and much easier compared with the agar dilution method. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We compared levofloxacin (1μg/disk) disk diffusion method to E test against 212 Helicobacter pylori strains. Using diameter breakpoints for susceptibility (≥15mm) and resistance (≤9mm), very major error, major error rate, and categoric agreement were 0.0%, 0.6%, and 93.9%, respectively. The method may be useful in low-resource laboratories.
    No preview · Article · Oct 2015 · Diagnostic microbiology and infectious disease
    • "In fact, the antibiotic resistance, in particular the clarithromycin resistance, can compromise the eradication rate significantly [8] and the more recent increasing resistance rate to quinolones strongly suggests to monitor the H. pylori resistance to improve its eradication [9] [10]. A recent European surveillance study [11] confirms the increasing rate of clarithromycin resistance that can largely contribute to the therapy failure against the microrganism. On this line, the Maastricht IV Consensus Report recommends to avoid clarithromycin use when its resistance rate is more than 15-20% [12]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Helicobacter pylori expresses an increased resistance in respect to antimicrobials currently used in therapy. The aim of this study was to evaluate the antimicrobial profiles of H. pylori isolates to nine conventional antibiotics used in a Central Region (Abruzzo) of Italy. Materials and methods: Biopsies were taken from antrum and fundus of 112 adult and 3 children with Urea Breath Test positive with dyspeptic symptoms and analyzed for H. pylori culture and antibacterial activity. Antimicrobial susceptibility tests were performed for clarithromycin, metronidazole, levofloxacin, moxifloxacin, ciprofloxacin, tetracycline, amoxicillin, ampicillin, and rifabutin by a modified agar dilution susceptibility test. Results: Bacterial culture was successful in 100 out of 115 patients. Helicobacter pylori strains were isolated from 98 antrum and 83 fundus samples. The rate of recovery of H. pylori strains was 90.50% (181/200). The percentages of resistance were as follows: clarithromycin 72.44% antrum, 72.28% fundus; metronidazole 34.69% antrum, 42.16% fundus; levofloxacin 42.85% antrum, 53.01% fundus; moxifloxacin 37.35% antrum, 46.57% fundus; ciprofloxacin 39.47% antrum, 44.28% fundus; tetracycline 2.63% antrum, 2.85% fundus; amoxicillin 1.02% antrum, 1.20% fundus; ampicillin 0% antrum and fundus and rifabutin 0% antrum, 1.20% fundus. A total of 35 subjects harbored multi-resistant strains. Conclusions: This study underlines the high rate of resistance to clarithromycin, metronidazole and quinolones, which may reflect an overuse of them. Culture and susceptibility test, should be performed to prevent the emergence of multi-resistance and to assess an efficacious regimen.
    No preview · Article · Oct 2015 · Scandinavian Journal of Gastroenterology
Show more