Primary Helicobacter pylori resistance to metronidazole and clarithromycin in the Finnish population

Abstract

SUMMARYAim: To systematically determine Helicobacter pylori primary antimicrobial resistance in Finland and the associated demographic and clinical features. Methods: A total of 342 adult patients referred for gastroscopy at 23 centres in different parts of Finland and positive for the rapid biopsy urease test were recruited. Clinical and demographic data were collected via a structured questionnaire. Patients with positive H. pylori culture and successful antibiotic sensitivity determination by the E-test method (n ¼ 292) were included in the present analysis. Results: The study population consisted of 134 men and 158 women, mean age 56 years (95% CI, 55-58 years). Resistance to metronidazole was 38% (110 of 292) and to clarithromycin 2% (seven of 292). Resistance to metronidazole was higher in women than in men (48% vs. 25%, P < 0.001).Previous use of antibiotics for gynaecological infections predicted metronidazole resistance (P ¼ 0.01), and previous use of antibiotics for respiratory (P ¼ 0.02) and dental infections (P ¼ 0.02) the clarithromycin resistance. We observed no major geographical variations in metronidazole resistance. Conclusions: The primary metronidazole resistance of H. pylori was 38% and was common in women previously treated for gynaecological infections. Primary clarithromycin resistance was uncommon (2%) and may associate with previous dental and respiratory infections.

Recent trends in primary antimicrobial resistance of Helicobacter pylori in Finland

“…The latter finding is in accordance with many earlier studies [6,18]. Resistance to levofloxacin did not show any gender differences in this study, whereas clarithromycin resistance was significantly more common in women than in men.…”

“…In Finland, the prevalence of primary clarithromycin resistance (before any eradication attempts) was as low as 2% in 2000-2001, whereas metronidazole resistance was 38% [18], this latter figure being in line with some early reports [9]. The aim of this study was to evaluate the recent possible changes in primary antimicrobial resistance of H. pylori isolated from Finnish patients during a 9-year period to determine whether increasing resistance trends reported from elsewhere could be detected.…”

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

“…In some studies, H. pylori resistance to clarithromycin has been linked to years (recent vs previous) of study, prior use of macrolides for respiratory or dental infections, patient age, female sex, race, non-ulcer disease, smoking and geographical region (Koivisto et al, 2004;Boyanova & Mitov, 2010).…”

“…pylori resistance to metronidazole has been associated with previous use of nitroimidazoles for gynaecological diseases, e.g. trichomoniasis and bacterial vaginosis, leading to higher resistance rates in women than in men, and use for parasitic diseases in some developing countries, leading to elevated resistance rates in inhabitants of or immigrants from these countries (McMahon et al, 2003;Koivisto et al, 2004;Mégraud, 2004aZullo et al, 2007O'Connor et al, 2010;Kostamo et al, 2011). In addition, resistance has been associated with birthplace and place of residence (Boyanova & Mitov, 2010).…”

“…to clarithromycin and quinolones, in many developed countries and those to metronidazole and tetracycline, mainly in some developing countries, increase over the years (Boyanova & Mitov, 2010). In some studies, primary H. pylori antibiotic resistance rates were shown to depend on countries or regions, national outpatient antibiotic use, prior use of the drug or similar agents for co-infections, patient age, sex, disease and co-morbidity, strain virulence (McMahon et al, 2003;Koivisto et al, 2004;Mégraud, 2004a;Boyanova & Mitov, 2010;Talebi Bezmin Abadi et al, 2010) and possibly other factors. Many of the reported factors are associated with previous use of the antibiotics.…”