The prevalence of clarithromycin resistance in Helicobacter pylori has nearly doubled during the last 10 years in Europe, no longer allowing its empirical use as a standard regimen to fight infection in many countries, a recent study reported.
Researchers designed a prospective review to assess the antibacterial resistance rates of H. pylori in Europe and to study the link between outpatient antibiotic use and resistance levels in various countries. The multicenter study, conducted in 18 countries from April 2008 to June 2009, included 2,204 patients (1,893 adults and 311 children).
H. pylori resistance rates for adults were 17.5% for clarithromycin, 14.1% for levofloxacin and 34.9% for metronidazole. By comparison, the resistance rate in adults was 9.8% for clarithromycin during a similar study held in 1998. The latest study also showed the rate of clarithromycin resistance was much higher in children (31.8%), but was lower for metronidazole (25.7%) and levofloxacin (2.5%). The differences in resistance between children and adults was statistically significant (P<.001).
A significant association also was found between outpatient quinolone use and the proportion of levofloxacin resistance in H. pylori (P=.0013) and between the use of long-acting macrolides alone and clarithromycin resistance (P=.036). Overall, macrolides usage was lower in Northern European countries compared with Western/Central and Southern European countries.
“Antibiotic use in the outpatient community was positively correlated with resistance for two major classes of antibiotics for the treatment of H. pylori infection,” researchers said. “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.”