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

Sibylle Koletzko ^1*, Fréderique Richy ², Patrick Bontems ³, Julia Crone ⁴, Nicolas Kalach ⁵, Maria Lurdes Monteiro ⁶, Frédéric Gottrand ⁷, Danuta Celinska-Cedro ⁸, Elefteria Roma-Giannikou ⁹, Giuseppina Oderda ¹⁰, Sanja Kolacek ¹¹, Pedro Urruzuno ¹², Maria Jose Martinez Gomez ¹³, Thomas Casswall ¹⁴, Merja Ashorn ¹⁵, Hedvig Bodanszky ¹⁶ and Francis Megraud ¹⁷

¹ Dr. v. Haunersches Kinderspital, University of Munich, Germany
² Université Victro Segalen Bordeaux, France
³ Queen Fabiola Children's Hospital, Burssels, Belgium
⁴ University Children's Hospital Vienna, Austria
⁵ Hopital Cochin-Sant Vincent de Paul, Paris, France
⁶ Centro de Bacteriologia, Instituto Nacional de Saude Dr. Ricardo Jorge, Lisboa, Portugal
⁷ Hopital J de Flandre, Lille, France
⁸ Children's Institute Warsaw, Poland
⁹ 1st Dept of Pediatrics, Aghia Sophia Children's Hosptial, Athens, Greece
¹⁰ Scienze Mediche, Clinica Pediatrica, Novara, Italy
¹¹ University Children's Hospital Zagreb, Croatia
¹² Hosptial 12 de octubre, Madrid, Spain
¹³ Hospital Nino Jesus, Madrid, Spain
¹⁴ Karolinska University Hospital, Sweden
¹⁵ Paeidatric Research Center Tampere, Finland
¹⁶ Semmelweis University, Budapest, Hungary
¹⁷ Inserm Eri 10, laboratoire de Becteriologie, Hopital Pellegrin, Bordeaux, France

^* To whom correspondence should be addressed. E-mail: sibylle.koletzko{at}med.uni-muenchen.de.

Accepted 16 March 2006

Abstract

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

METHODS: During a four year period, 17 paediatric centres from 14 European countries reported prospectively all H. pylori infected patients 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, 43% 6-11 years, and 44% >11 years of age. Testing was performed before the first therapy (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 (OR 1.58; 1.12-2.24, p=0.01), in children <6 years compared to >12 years (OR 1.82, 1.10- 3.03, p=0.020) and in patients living in Southern compared to Northern Europe (OR 2.25; 1.52-3.30, p<0.001). Overall resistance rate to metronidazole was 25% (A: 23%, B: 35%) and higher in children born outside Europe (A: adj. OR 2.42, 95% CI: 1.61-3.66, 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 non-ulcer patients (p=0.0013).

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.

Keywords: Helicobacter pylori in children, antibiotic resistance, clarithromycin, metronidazole, peptic ulcer disease

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