H. pylori resistance to clarithromycin doubles in Europe
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Over the last 20 years, Helicobacter pylori resistance to clarithromycin — an antibiotic commonly used to treat the infection — has more than doubled in Europe, increasing from 9.9% in 1998 to 21.6% in 2018, according to study findings presented at United European Gastroenterology Week.
“Culture and antimicrobial susceptibility testing are rarely performed, hence regular surveys are important to monitor resistance and infer treatments which can be used,” Francis Mégraud, MD, DPharm, professor of bacteriology at the University of Bordeaux in France, told Infectious Disease News. “As resistance rates increase, further treatment options will become limited or ineffective.”
According to the CDC, H. pylori infection is the major cause of peptic ulcers and gastritis and is associated with an up to six-fold increased risk for gastric cancer and mucosal associated-lymphoid-type lymphoma.
Using data from 18 countries, Mégraud and colleagues analyzed 1,232 patients with a positive H. pylori test. In 2018, they observed that 38.5% of strains were resistant to metronidazole, 21.9% to clarithromycin, 16.6% to levofloxacin, 3.8% to rifampicin compounds, 2.4% to amoxicillin and 0.3% to tetracycline.
Megraud noted that in northern countries, resistance is over the 15% threshold, which requires testing before prescribing.
“When it is not possible to test the patient’s H. pylori strain, it is important to have some knowledge on the global resistance in the country or area especially for clarithromycin and levofloxacin,” he said.
Southern Italy, Croatia and Greece had the highest rates of resistance to clarithromycin, at 39.9%, 34.6% and 30%, respectively, according to a news release. The high levels of resistance were attributed to the overuse of antibiotics in these countries, as well as limited support for antibiotic stewardship.
Megraud explained an important message for clinicians, highlighting the role that ID practitioners should take in limiting inappropriate antibiotic use.
“Have a prudent use of antibiotics [as] advised by WHO and [do] not use antibiotics when it is not necessary — for example for respiratory tract infection when bacteria are not involved,” he said. “There are now important programs in some countries for this purpose.” – by Marley Ghizzone
Reference:
Megraud F, et al. Abstract: OP035. Presented at United European Gastroenterology Week: Oct. 19-23, 2019; Barcelona, Spain.
Disclosures: Megraud reports that the researchers received free reagents from bioMérieux to obtain MICs to four antibiotics, and PCR kits from Mobidiag to perform controls on 10% of the sample.
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Herbert L. DuPont, MD, MACP
The survey looked at H. pylori susceptibility over the past 20 years in multiple European settings in patients with primary (first bout) infection. They found that 22% of the recent H. pylori isolates were resistant to clarithromycin, which was higher than in previous years.
WHO identified clarithromycin resistance as a public health problem in 2017, based on the fact that clarithromycin has been the most effective drug in the treatment of H. pylori, and rates of resistance are rising throughout the world.
In a multicenter study in the United States published in 2015, rates of clarithromycin resistance were already 33%. Rates of clarithromycin resistance have been shown to have regional differences.
Like other infections where antibiotic resistance is rising and influencing treatment choices, we need to explore other treatment options, both antimicrobial and nonantimicrobial, and treatment failures will need to be treated with other drug combinations. Antimicrobial susceptibility-guided triple therapy of H. pylori isolates has been suggested as one approach to management.
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