H. pylori antibiotic resistance increases in Europe
Macrolide and quinolone consumption positively correlated with Helicobacter pylori resistance in European countries, according to research published in Gut.
“Since 2010, a marked decrease in efficacy of this treatment regimen [standard triple therapy] has been observed globally, which resulted in the recommendation to prescribe quadruple therapies. The quadruple therapies have been shown to achieve higher success rates than standard triple therapy, but they may cause more frequent adverse events and lead to more antimicrobial resistance,” Francis Mégraud, MD, professor of bacteriology at the University of Bordeaux in Bordeaux, France, and colleagues wrote. “In this context, regularly performed point prevalence surveys to update the resistance rates are of great value to optimize the therapeutic choices and to continue using standard triple therapy whenever possible.”
In an observational, multicenter study, researchers analyzed 1,211 patients with H. pylori to assess the proportion of antibiotic resistance rates and their corresponding risk factors. They further studied the link between antibiotic consumption in the community and resistance levels using generalized linear mixed models.
According to H. pylori culture and susceptibility testing, antibiotic resistance rates were 38.9% for metronidazole, 21.4% for clarithromycin and 15.8% for levofloxacin. Further analysis yielded a significant association between clarithromycin resistance and 2013 community consumption of macrolides (incidence rate ratio (IRR) = 1.17; 95% CI 1.07-1.29), intermediate-acting macrolides (IRR = 1.16; 95% CI 1.05-1.28) and long-acting macrolides (IRR = 1.8; 95% CI 1.11-2.92). There was also a significant association between levofloxacin resistance and 2013 community consumption of quinolones (IRR = 1.57; 95% CI 1.29-1.92) as well as second-generation quinolones (IRR = 1.63; 95% CI 1.31-2.03).
“For clarithromycin, the resistance rate has increased since 2008 and continues to do so but to a lesser extent than between 1998 and 2008, indicating that there is still a need to test before prescribing this antibiotic in many countries. A significant increase is also observed for metronidazole, while levofloxacin resistance appears to be stable,” Megraud and colleagues concluded. “In addition, the positive correlation between H. pylori resistance and the consumption of the corresponding antibiotics in the community was confirmed.”