Antibacterial resistance and the success of tailored triple therapy in Helicobacter pylori strains isolated from Slovenian children

Abstract

BackgroundPrimary Helicobacter pylori (H. pylori) infection occurs predominantly in childhood. Antimicrobial resistance is the leading cause for H. pylori eradication failure. The aims of this study were (i) to establish for the first time the antimicrobial resistance of H. pylori strains in infected Slovenian children not previously treated for H. pylori infection and (ii) to evaluate the effectiveness of tailored triple therapy, assuming that eradication rate with tailored triple therapy will be >90%.MethodsData on all treatment‐naive children 1‐18 years old and treated for H. pylori infection according to susceptibility testing were retrospectively analyzed. All relevant clinical information and demographical information were retrospectively collected from the hospital information systems and/or patients’ medical documentation.ResultsThe inclusion criteria were met by 107 children (64.5% girls) with a median age of 12.0 years (range 2.0‐17.6 years). Primary antimicrobial resistance rates of H. pylori were 1.0% to amoxicillin (AMO), 23.4% to clarithromycin (CLA), 20.2% to metronidazole (MET), 2.8% to levofloxacin (LEV), and 0.0% to tetracycline (TET). Dual resistances were detected to CLA and MET in 11.5% (n=12) of strains, to CLA and LEV in 2.8% (n=3), and to MET and LEV in 2.9% (n=3). Results of treatment success were available for 71 patients (66.2% girls). Eradication of H. pylori was evaluated using the 13C‐urea breath test, monoclonal stool antigen test or in some cases with repeated upper GI endoscopy with histology and cultivation/molecular tests. Eradication was achieved in 61 of 71 (85.9%) patients.ConclusionsThe primary resistance rates of H. pylori to CLA and MET in Slovenia are high. Our data strongly support the fact that in countries with high prevalence of resistant H. pylori strains susceptibility testing and tailored therapy is essential.

Phenotypic and Genotypic Analysis of Resistant Helicobacter pylori Strains Isolated from Children with Gastrointestinal Diseases

“…Similar increasing trends in CH resistance in children was observed by other authors from Europe and Asia [ 22 , 23 , 24 ]. The single resistance of H. pylori strains isolated from children to MET in our region remains stable, but high (from 28.6% in the period from 2008–2012 to current 31%), similar to other European countries (15–30%), but it is much higher in Iran (60%) and in China (68%) [ 13 , 20 , 21 , 22 , 25 , 26 , 27 , 28 ]. The increase in dual resistance to CH and MET from 14% to 35% detected in our study is particularly alarming.…”

Increasing antimicrobial resistance to clarithromycin and metronidazole in pediatric Helicobacter pylori infection in southern Taiwan: A comparison between two decades

“…As the results in this study, the amoxicillin resistance rate of pediatric isolates was reported to be low (<1%) in 2010 . Although high amoxicillin resistance rates of pediatric H pylori were reported in Korea (24.2% in 2005‐2009) and in Brazil (10.4% in 2008‐2009) even with cutoff values of 0.5 μg/mL and 2 μg/mL, respectively, the resistance rate remains low in countries with a previous low rate, including Taiwan . In this study, the amoxicillin‐resistant rate of pediatric H pylori was 4.9% measured by the E test in a 10‐year surveillance (2009‐2018).…”

“…However, a marked reduction in eradication rate has been reported if there is coresistance to clarithromycin and metronidazole . The overall coresistance rate to clarithromycin and metronidazole of pediatric H pylori isolates after 2000 ranged 7.7%‐11.5% worldwide . Surprisingly, a very high coresistance rate of both drugs was found (50.7%) in pediatric isolates in Beijing from 2009 to 2010 .…”

“…Frequent use of antibiotics (amoxicillin and clarithromycin in children; levofloxacin in adults) may lead to development of antibiotic‐resistant strains. Resistance to tetracycline of pediatric H pylori isolates is very rare . Although the ESPGHAN/NASPGHAN guidelines for pediatric H pylori eradication do not suggest levofloxacin and tetracycline, eradication therapy containing levofloxacin and tetracycline may be an alternative strategy in areas with a high prevalence of dual resistance and where bismuth is not available.…”

“…In order to obtain >90% H pylori eradication in pediatric first‐line therapy, a strategy tailored to antimicrobial susceptibility is recommended . Moreover, adherence to therapy can affect the eradication rate .…”