Numerous risk factors for Helicobacter pylori antibiotic resistance revealed by extended anamnesis: a Bulgarian study

Abstract

The aim of this study was to assess risk factors for primary Helicobacter pylori antibiotic resistance by an extended anamnesis. In total, 519 H. pylori strains from untreated symptomatic adults who answered a questionnaire were evaluated. Strain susceptibility was assessed by a breakpoint susceptibility test. Primary resistance rates were 29.5 % for metronidazole, 17.9 % for clarithromycin, 7.3 % for metronidazole+clarithromycin, 4.0 % for tetracycline and 10.8 % for ciprofloxacin. On multivariate analysis, younger (¡65 years) age was an independent predictor for metronidazole resistance. To our knowledge, for the first time, being a member of the health-care profession was revealed as a risk factor for H. pylori resistance to metronidazole and both metronidazole and clarithromycin. Respiratory and urinary tract infections were independent predictors of clarithromycin and ciprofloxacin resistance, respectively. The presence of co-infections was an independent risk factor for clarithromycin, metronidazole and ciprofloxacin resistance. Surprisingly, female sex was the only predictor for tetracycline resistance. The antibiotic resistance rates were not associated with disease type, place of residence, birthplace, educational level, non-steroidal anti-inflammatory drug or proton pump inhibitor use, smoking or dietary factors, such as consumption of coffee, yogurt, green tea, raw garlic, raw onion, honey or meat. There was a trend for higher metronidazole resistance in strains from diabetic patients. In conclusion, the extended anamnesis of H. pylori-positive patients should include data on patient age, sex, whether they are in the health-care profession, co-infections and possibly diabetes to improve the choice of empiric therapy. Tailored treatment based on the extended anamnesis is suggested, and susceptibility testing of the strains is recommended for patients at risk for antibiotic resistance, especially to clarithromycin, fluoroquinolones or both metronidazole and clarithromycin.

The Incidence of Primary Antibiotic Resistance of Helicobacter pylori in Vietnam

“…Other fluoroquinolones such as nalidixic acid, ciprofloxacin, and ofloxacin, which are commonly used in Vietnam, may lead to cross resistance with LVFX. On the other hand, TC resistance was rare (5.8%), which is consistent with that reported in previous studies from other countries 44–46 . TC is not often used for infectious diseases in Vietnam.…”

Prevalence of Primary Resistance of <b><i>Helicobacter pylori</i></b> to Clarithromycin and Levofloxacin in Southern Spain

“…At present, there is no good explanation for the influence of female sex on the increased rate of CLAr, but it could be related to the large-scale use of this kind of antibiotic against urinary infections [20]. On the other hand, we recorded an increased risk of LFr with age, a result that was to be expected taking into consideration the greatly extended use of second-generation quinolones (ciprofloxacin), and in the past few years, especially, the increased use of third-generation quinolones (LF and moxifloxacin) for respiratory infections.…”

Primary clarithromycin resistance toHelicobacter pylori: Is this the main reason for triple therapy failure?

“…The phenomenon was found to be more evident in females. A possible explanation for this finding may be a wider use of the antibiotic in the course of infections with a greater prevalence in the female sex, such as urinary tract infections [11,12] . A more recent study (2011) was focused on the whole of Italy, including about 20 patients from each region at the first endoscopic diagnosis of H. pylori infection.…”