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Gut 55:1711-1716 doi:10.1136/gut.2006.091272
  • Helicobacter pylori

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

  1. S Koletzko1,
  2. F Richy2,
  3. P Bontems3,
  4. J Crone4,
  5. N Kalach5,
  6. M L Monteiro6,
  7. F Gottrand7,
  8. D Celinska-Cedro8,
  9. E Roma-Giannikou9,
  10. G Orderda10,
  11. S Kolacek11,
  12. P Urruzuno12,
  13. M J Martínez-Gómez13,
  14. T Casswall14,
  15. M Ashorn15,
  16. H Bodanszky16,
  17. F Mégraud2,
  18. on behalf of the European Paediatric Task Force on Helicobacter pylori
  1. 1Dr v Haunersches Kinderspital, Munich, Germany
  2. 2INSERM ERI 10 Université Victor Segalen Bordeaux 2, Bordeaux, France
  3. 3Queen Fabiola Children’s Hospital, Brussels, Belgium
  4. 4University of Vienna, Austria
  5. 5Hopital Cochin-Saint Vincent de Paul, Paris, France
  6. 6Instituto Nacional Saúde Dr Ricardo, Lisboa, Portugal
  7. 7Hopital J de Flandre, Lille, France
  8. 8Children’s Institute, Warsaw, Poland
  9. 91st Department of Paediatric of Athens University, Athens, Greece
  10. 10Universita del Piemonte Orientale, Novara, Italy
  11. 11Children’s Hospital, Zagreb, Croatia
  12. 12Hospital de 12 Octubre, Madrid, Spain
  13. 13Hospital Niño Jesús, Madrid, Spain
  14. 14Karolinska University Hospital, Stockholm, Sweden
  15. 15University Hospital and University of Tampere, Finland
  16. 16Semmelweis University, Budapest, Hungary
  1. 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
  • Accepted 16 March 2006
  • Revised 5 March 2006
  • Published Online First 7 April 2006

Abstract

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.

Footnotes

  • Published Online First 7 April 2006

  • Competing interests: None declared.