Primary Antimicrobial Susceptibility Changes in Children withHelicobacter pyloriInfection over 13 Years in Northern Italy

Abstract

The eradication therapy of Helicobacter pylori (H. pylori) infection is still a challenge for gastroenterologists. One of the main causes of failure in H. pylori eradication is the antibiotic resistance mainly to clarithromycin. Culture from biopsies is maybe the most used method among the antimicrobial susceptibility techniques. In this study, we compared the antimicrobial susceptibility changes in children with H. pylori infection over 13 years and we confirmed that clarithromycin resistance has been increased (16% versus 26%) though with no statistically signficant value. Therefore, clarithromycin should not be used in empiric treatment of H. pylori eradication therapy in children, but its use should be limited only to children with known antimicrobial susceptibility. On the other hand, metronidazole resistance has decreased over this time period in statistically significant manner (56% versus 33%, p = 0.014). Furthermore, ampicillin resistance has been confirmed to be very rare (3% versus 0%) in children with H. pylori infection. In conclusion, in H. pylori infection, if we do not know the antibiotic susceptibility of patients, we should recommend an eradication therapy based on the local distribution of antibiotic resistance rates trying to limit the therapeutic failures.

Antibiotic resistance of Helicobacter pylori in Chinese children: A multicenter retrospective study over 7 years

“…[5][6][7][8][12][13][14] No significant change was seen in the metronidazole resistance rates in the consecutive years. The high rate of metronidazole resistance was detected in this region (75.20%), where resistance rate was higher than that in other regions of China and other countries (from 10.1% to 61.6%).…”

“…The rate of resistance to clarithromycin in children varies among different countries, such as 18.8% in South Korea, 15 11.9%-34.7% in Europe 5,7,12,13 , and 21.6% in Austria. The prescription of this drug in children during the last decade for respiratory tract infections might contribute to a high resistance rate of H. pylori to clarithromycin.…”

“…13,16 Quinolone is relatively contraindicated in pediatric patients (less than 18 years of age). 8,12,13 However, high resistance rates to amoxicillin in children were reported in several regions, for instance, 24.2% in South Korea 15 and 14.3% in Iran. 15 The reason for levofloxacin resistance in children may because of the transmission of drug-resistant strains from adults to children.…”

Primary antibiotic resistance of Helicobacter pylori strains among adults and children in a tertiary referral centre in Lithuania

“…Resistance rates of metronidazole in both adult and children populations were relatively high – 32.8% and 25%, respectively. Metronidazole resistance remains high across Europe with no major changes in 10 years or regional distribution ().…”

Helicobacter pylori in children

“…Manfredi et al . evaluated the variations in primary antibiotic susceptibility in children with H. pylori infection in Northern Italy over the last 13 years.…”