Antibiotic Resistance Prevalence and Trends in Patients Infected with Helicobacter pylori in the Period 2013–2020: Results of the European Registry on H. pylori Management (Hp-EuReg)

Abstract

Background: Bacterial antibiotic resistance changes over time depending on multiple factors; therefore, it is essential to monitor the susceptibility trends to reduce the resistance impact on the effectiveness of various treatments. Objective: To conduct a time-trend analysis of Helicobacter pylori resistance to antibiotics in Europe. Methods: The international prospective European Registry on Helicobacter pylori Management (Hp-EuReg) collected data on all infected adult patients diagnosed with culture and antimicrobial susceptibility testing positive results that were registered at AEG-REDCap e-CRF until December 2020. Results: Overall, 41,562 patients were included in the Hp-EuReg. Culture and antimicrobial susceptibility testing were performed on gastric biopsies of 3974 (9.5%) patients, of whom 2852 (7%) were naive cases included for analysis. The number of positive cultures decreased by 35% from the period 2013–2016 to 2017–2020. Concerning naïve patients, no antibiotic resistance was found in 48% of the cases. The most frequent resistances were reported against metronidazole (30%), clarithromycin (25%), and levofloxacin (20%), whereas resistances to tetracycline and amoxicillin were below 1%. Dual and triple resistances were found in 13% and 6% of the cases, respectively. A decrease (p < 0.001) in the metronidazole resistance rate was observed between the 2013–2016 (33%) and 2017–2020 (24%) periods. Conclusion: Culture and antimicrobial susceptibility testing for Helicobacter pylori are scarcely performed (<10%) in Europe. In naïve patients, Helicobacter pylori resistance to clarithromycin remained above 15% throughout the period 2013–2020 and resistance to levofloxacin, as well as dual or triple resistances, were high. A progressive decrease in metronidazole resistance was observed.

Clinical trial: seven‐day vonoprazan‐ versus 14‐day proton pump inhibitor‐based triple therapy for first‐line Helicobacter pylori eradication

“…Current guidelines recommend triple therapy with amoxicillin 1 g and clarithromycin 500 mg twice daily for 14 days as first‐line eradication therapy in regions with low clarithromycin resistance (<15%) 3,11,12 . Reports of inadequate eradication rates (<80%) with clarithromycin‐containing regimens due to increasing antimicrobial resistance in Asia and Europe are of major concern 7,13–16 . International guidelines recommend four‐drug bismuth‐based combination therapies 3,11,12 as first‐line treatment in areas of high clarithromycin resistance, defined as a prevalence of >15% based on Maastricht V 3 and the Toronto 12 consensus or a prevalence of >20% based on American College of Gastroenterology (ACG) 11 guidelines.…”

“…3,11,12 Reports of inadequate eradication rates (<80%) with clarithromycincontaining regimens due to increasing antimicrobial resistance in Asia and Europe are of major concern. 7,[13][14][15][16] International guidelines recommend four-drug bismuth-based combination therapies 3,11,12 as first-line treatment in areas of high clarithromycin resistance, defined as a prevalence of >15% based on Maastricht V 3 and the Toronto 12 consensus or a prevalence of >20% based on American College of Gastroenterology (ACG) 11 guidelines. However, the complexity, high pill burden and increased side effects of quadruple regimens reduce compliance rates.…”

Empirical vs. Susceptibility-Guided Treatment of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

“…(5) Even knowing the susceptibility of H. pylori , eradication rates do not achieve 100%, as the results observed in vivo by following in vitro susceptibility to antibiotics are often disappointing (Guslandi, 2001 ; Gisbert and Pajares, 2002 ; Zullo et al, 2003 ; Baylina et al, 2019 ). The reverse situation is also possible, as H. pylori eradication may, nonetheless, be achieved in the presence of H. pylori metronidazole- or clarithromycin-resistant strains even with a drug combination including these antibiotics (Zullo et al, 2003 ; Bujanda et al, 2020 , 2021 ). Furthermore, probably due to the synergistic effect of bismuth, the addition of this drug to triple therapy with clarithromycin may allow achieving a cure rate of approximately 90% even in patients with resistance against this antibiotic (Gisbert and McNicholl, 2017 ; Gisbert and Nyssen, 2021 ).…”

Eradication of Helicobacter pylori: what determines the effectiveness antihelicobacter pharmacotherapy (according to the results of the analysis of urease breath tests performed in 2006-2019 in Vinnytsia region)

“…У більш пізньому дослідженні L. Bujanda et al (2021), проведеному у 2013-2020 роках в країнах Європи, був зроблений аналіз близько 4 000 зразків біопсійного матеріалу, взятого у носіїв H.p. Отримані результати продемонстрували високу резистентність до трьох найчастіше використовуваних антибіотиків -кларитроміцину, левофлоксацину та метронідазолу (резистентність склала 25%, 20% та 30% відповідно).…”