H. pylori, Antibiotic Resistance, and Antibiotic Consumption
H. pylori, Antibiotic Resistance, and Antibiotic Consumption
Objective 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.
Design 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.
Results 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).
Conclusion 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.
The discovery of Helicobacter pylori and of its role in peptic ulcer disease constituted a breakthrough in the field of gastroenterology. Eradication treatments have been developed during the last 20 years leading to a decrease in H pylori-related peptic ulcer disease and in the prevalence of the infection in the Western world. However, the success of these treatments is now compromised by the increase in antimicrobial resistance of H pylori. Clarithromycin resistance in particular has a major negative impact on the efficacy of the recommended first-line triple therapy and a progressive increase in the prevalence of resistance to this antibiotic may limit its use. By contrast, metronidazole resistance, although highly prevalent, can be partly overcome and is of secondary importance. As antibiotic resistance is an evolving process, it is mandatory to carry out point prevalence surveys on a regular basis in order to guide clinicians in the therapeutic choice. Such surveys were previously carried out in Europe in 1991 and in 1998. Our aim was to report on the results of the latest survey (2008–9) and to examine the association with the outpatient antibiotic consumption in Europe over an 8-year period (2001–8).
Abstract and Introduction
Abstract
Objective 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.
Design 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.
Results 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).
Conclusion 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.
Introduction
The discovery of Helicobacter pylori and of its role in peptic ulcer disease constituted a breakthrough in the field of gastroenterology. Eradication treatments have been developed during the last 20 years leading to a decrease in H pylori-related peptic ulcer disease and in the prevalence of the infection in the Western world. However, the success of these treatments is now compromised by the increase in antimicrobial resistance of H pylori. Clarithromycin resistance in particular has a major negative impact on the efficacy of the recommended first-line triple therapy and a progressive increase in the prevalence of resistance to this antibiotic may limit its use. By contrast, metronidazole resistance, although highly prevalent, can be partly overcome and is of secondary importance. As antibiotic resistance is an evolving process, it is mandatory to carry out point prevalence surveys on a regular basis in order to guide clinicians in the therapeutic choice. Such surveys were previously carried out in Europe in 1991 and in 1998. Our aim was to report on the results of the latest survey (2008–9) and to examine the association with the outpatient antibiotic consumption in Europe over an 8-year period (2001–8).
