@article {Megraud1815, author = {Francis Megraud and Robin Bruyndonckx and Samuel Coenen and Linda Wittkop and Te-Din Huang and Martin Hoebeke and Lucie B{\'e}n{\'e}jat and Philippe Lehours and Herman Goossens and Youri Glupczynski}, editor = {, and , and Makristathis, Athanasios and Boyanova, Lyudmila and Tonkic, Ante and Tonkic, Marija and Andersen, Leif and Blumel, Benjamin and Glocker, Erick and Tammer, Ina and Link, Alexander and Suerbaum, Sebastian and Dichtl, Karl and Mentis, Andreas and Marintez-Gonzales, Beatriz and Smith, Sinead and McNamara, Deirdre and Dore, Maria Pina and Monno, Rosa and Lippolis, Antonio and Rudzite, Dace and Leja, Marcis and Kupcinskas, Juozas and Melby, Kjetil K. and Gosciniak, Grazyna and Karpinski, Tomasz M and Oleastro, Monica and Jeverica, Samo and Calvet, Xavier and Ramirez-L{\'a}zaro, Maria Jos{\'e} and Ros, Milagrosa Montes and Morilla, Ana and Boonstra, Sjoukje and Schneeberger, Peter M}, title = { Helicobacter pylori resistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community}, volume = {70}, number = {10}, pages = {1815--1822}, year = {2021}, doi = {10.1136/gutjnl-2021-324032}, publisher = {BMJ Publishing Group}, abstract = {Objective Our aim was to prospectively assess the antibiotic resistance rates in Helicobacter pylori strains in Europe in 2018 and to study the link between antibiotic consumption in the community and H. pylori resistance levels in the different countries.Design The proportion of primary antibiotic resistance cases of H. pylori and their corresponding risk factors were investigated in 24 centres from 18 European countries according to a standardised protocol. Data on antibiotic consumption in the community were collected for the period 2008{\textendash}2017. The link between antibiotic consumption and resistance data was assessed using generalised linear mixed models. The model with the best fit was selected by means of the Akaike Information Criterion.Results H. pylori resistance rates for the 1211 adult patients included were 21.4\% for clarithromycin, 15.8\% for levofloxacin and 38.9\% for metronidazole and were significantly higher in Central/Western and Southern than in the Northern European countries.The best model fit was obtained for the Poisson distribution using 2013 consumption data. A significant association was found between H. pylori clarithromycin resistance and consumption in the community of macrolides (p=0.0003) and intermediate-acting macrolides (p=0.005), and between levofloxacin resistance and consumption of quinolones (p=0.0002) and second-generation quinolones (p=0.0003).Conclusion This study confirms the positive correlation between macrolide and quinolone consumption in the community and corresponding H. pylori resistance in European countries. Hence, H. pylori treatment with clarithromycin and levofloxacin should not be started without susceptibility testing in most European countries.Data are available on reasonable request at ORCID number: 0000-0002-2481-1612.}, issn = {0017-5749}, URL = {https://gut.bmj.com/content/70/10/1815}, eprint = {https://gut.bmj.com/content/70/10/1815.full.pdf}, journal = {Gut} }