Helicobacter pyloriresistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community

Abstract

ObjectiveOur aim was to prospectively assess the antibiotic resistance rates in Helicobacter pylori strains in Europe in 2018 and to study the link between antibiotic consumption in the community and H. pylori resistance levels in the different countries.DesignThe proportion of primary antibiotic resistance cases of H. pylori and their corresponding risk factors were investigated in 24 centres from 18 European countries according to a standardised protocol. Data on antibiotic consumption in the community were collected for the period 2008–2017. The link between antibiotic consumption and resistance data was assessed using generalised linear mixed models. The model with the best fit was selected by means of the Akaike Information Criterion.ResultsH. pylori resistance rates for the 1211 adult patients included were 21.4% for clarithromycin, 15.8% for levofloxacin and 38.9% for metronidazole and were significantly higher in Central/Western and Southern than in the Northern European countries.The best model fit was obtained for the Poisson distribution using 2013 consumption data. A significant association was found between H. pylori clarithromycin resistance and consumption in the community of macrolides (p=0.0003) and intermediate-acting macrolides (p=0.005), and between levofloxacin resistance and consumption of quinolones (p=0.0002) and second-generation quinolones (p=0.0003).ConclusionThis study confirms the positive correlation between macrolide and quinolone consumption in the community and corresponding H. pylori resistance in European countries. Hence, H. pylori treatment with clarithromycin and levofloxacin should not be started without susceptibility testing in most European countries.

Diagnosis of Helicobacter pylori Infection and Recent Advances

“…One meta-analysis including 178 studies from 65 countries in World Health Organization Regions reported primary and secondary resistance rates to clarithromycin, metronidazole, and levofloxacin were ≥15% [21]. A prospective study investigated in 24 centers from 18 European countries reported that primary antibiotic resistance of H. pylori was 21.4% for clarithromycin, 15.8% for levofloxacin, and 38.9% for metronidazole, associated with the consumption in the community of macrolides and intermediate-acting macrolides [22]. One research covering 176 articles from 24 countries in the Asia-Pacific region showed primary H. pylori resistance rates were 17% for clarithromycin, 44% for metronidazole, 18% for levofloxacin, 3% for amoxicillin, and 4% for tetracycline [23].…”

Antibiofilm and Antimicrobial-Enhancing Activity of Chelidonium majus and Corydalis cheilanthifolia Extracts against Multidrug-Resistant Helicobacter pylori

“…As many experts point out, the frequency of overuse and inappropriate prescription of antibiotics in the treatment of bacterial infections throws a shadow on the possible future utilization of many of them [4,8,9,23]. This issue is of particular importance because over the last 20 years a rapid increase in antibiotic resistance of H. pylori has been observed, and a very limited array of antibiotics are left in the treatment of multidrugresistant strains of this bacterium [5,23]. Therefore, intensive search for new compounds displaying anti-H. pylori activity (as performed in this study) is of pivotal usability with regard to future treatment algorithms.…”

“…Currently, the treatment of H. pylori has reached the point where the majority of traditional methods of its eradication have lost their effectiveness [3]. H. pylori antibiotic resistance is the main cause of these therapeutic failures and a major challenge for clinicians [5]. The latest data on H. pylori antibiotic resistance in Europe showed that the level of primary resistance of this bacterium was 21.8% for clarithromycin (CLR), 15.8% for levofloxacin (LEV), and 38.9% for metronidazole (MTZ) [5].…”

“…H. pylori antibiotic resistance is the main cause of these therapeutic failures and a major challenge for clinicians [5]. The latest data on H. pylori antibiotic resistance in Europe showed that the level of primary resistance of this bacterium was 21.8% for clarithromycin (CLR), 15.8% for levofloxacin (LEV), and 38.9% for metronidazole (MTZ) [5]. The results of this European study are consistent with both world-level [6] and national-level data published by our team [7].…”

Combined antrum and corpus biopsy protocol improves Helicobacter pylori culture success

“…Primary resistance rates for clarithromycin, metronidazole and levofloxacin are 15% or higher in nearly all WHO regions[ 3 ]. Recent data on H. pylori antimicrobial resistance in European countries revealed overall primary resistance rates of 21.4%, 15.8% and 38.9% for clarithromycin, levofloxacin and metronidazole, respectively[ 4 ]. As resistance rates vary from region to region[ 3 - 5 ], consensus guidelines[ 6 - 11 ] recommend that first-line treatment for H. pylori is based on primary resistance rates in a given population.…”