HELICOBACTER PYLORI

Prospective multicentre study on antibiotic resistance of Helicobacter pylori strains obtained from children living in Europe

S Koletzko¹, F Richy², P Bontems³, J Crone⁴, N Kalach⁵, M L Monteiro⁶, F Gottrand⁷, D Celinska-Cedro⁸, E Roma-Giannikou⁹, G Orderda¹⁰, S Kolacek¹¹, P Urruzuno¹², M J Martínez-Gómez¹³, T Casswall¹⁴, M Ashorn¹⁵, H Bodanszky¹⁶, F Mégraud² on behalf of the European Paediatric Task Force on Helicobacter pylori

¹ Dr v Haunersches Kinderspital, Munich, Germany
² INSERM ERI 10 Université Victor Segalen Bordeaux 2, Bordeaux, France
³ Queen Fabiola Children’s Hospital, Brussels, Belgium
⁴ University of Vienna, Austria
⁵ Hopital Cochin-Saint Vincent de Paul, Paris, France
⁶ Instituto Nacional Saúde Dr Ricardo, Lisboa, Portugal
⁷ Hopital J de Flandre, Lille, France
⁸ Children’s Institute, Warsaw, Poland
⁹ 1st Department of Paediatric of Athens University, Athens, Greece
¹⁰ Universita del Piemonte Orientale, Novara, Italy
¹¹ Children’s Hospital, Zagreb, Croatia
¹² Hospital de 12 Octubre, Madrid, Spain
¹³ Hospital Niño Jesús, Madrid, Spain
¹⁴ Karolinska University Hospital, Stockholm, Sweden
¹⁵ University Hospital and University of Tampere, Finland
¹⁶ Semmelweis University, Budapest, Hungary

Correspondence to:
Professor S Koletzko
Dr v Haunersches Kinderspital, Ludwig Maximilians University, Lindwurmstr 4, D-80337 Munich, Germany; Sibylle.Koletzko{at}med.uni-muenchen.de

Aim: To prospectively assess the antibacterial resistance rate in Helicobacter pylori strains obtained from symptomatic children in Europe.

Methods: During a 4-year period, 17 paediatric centres from 14 European countries reported prospectively on patients infected with H pylori, for whom antibiotic susceptibility was tested.

Results: A total of 1233 patients were reported from Northern (3%), Western (70%), Eastern (9%) and Southern Europe (18%); 41% originated from outside Europe as indicated by mother’s birth-country; 13% were <6 years of age, 43% 6–11 years of age and 44% >11 years of age. Testing was carried out before the first treatment (group A, n = 1037), and after treatment failure (group B, n = 196). Overall resistance to clarithromycin was detected in 24% (mean, A: 20%, B: 42%). The primary clarithromycin resistance rate was higher in boys (odds ratio (OR) 1.58; 1.12 to 2.24, p = 0.01), in children <6 years compared with >12 years (OR 1.82, 1.10 to 3.03, p = 0.020) and in patients living in Southern Europe compared with those living in Northern Europe (OR 2.25; 1.52 to 3.30, p<0.001). Overall resistance rate to metronidazole was 25% (A: 23%, B: 35%) and higher in children born outside Europe (A: adjusted. OR 2.42, 95% CI: 1.61 to 3.66, p<0.001). Resistance to both antibiotics occurred in 6.9% (A: 5.3%, B: 15.3%). Resistance to amoxicillin was exceptional (0.6%). Children with peptic ulcer disease (80/1180, 6.8%) were older than patients without ulcer (p = 0.001).

Conclusion: The primary resistance rate of H pylori strains obtained from unselected children in Europe is high. The use of antibiotics for other indications seems to be the major risk factor for development of primary resistance.

Abbreviations: MIC, minimal inhibitory concentration

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