title: Prospective multicentre study on antibiotic resistance of Helicobacter pylori strains obtained from children living in Europe.
abstract: OBJECTIVE
  To prospectively assess the antibacterial resistance rate in Helicobacter pylori strains obtained from symptomatic children in Europe.
  
  
  METHODS
  During a 4-year period, 17 paediatric centres from 14 European countries reported prospectively on patients infected with H pylori, for whom antibiotic susceptibility was tested.
  
  
  RESULTS
  A total of 1233 patients were reported from Northern (3%), Western (70%), Eastern (9%) and Southern Europe (18%); 41% originated from outside Europe as indicated by mother's birth-country; 13% were <6 years of age, 43% 6-11 years of age and 44% >11 years of age. Testing was carried out before the first treatment (group A, n = 1037), and after treatment failure (group B, n = 196). Overall resistance to clarithromycin was detected in 24% (mean, A: 20%, B: 42%). The primary clarithromycin resistance rate was higher in boys (odds ratio (OR) 1.58; 1.12 to 2.24, p = 0.01), in children <6 years compared with >12 years (OR 1.82, 1.10 to 3.03, p = 0.020) and in patients living in Southern Europe compared with those living in Northern Europe (OR 2.25; 1.52 to 3.30, p<0.001). Overall resistance rate to metronidazole was 25% (A: 23%, B: 35%) and higher in children born outside Europe (A: adjusted. OR 2.42, 95% CI: 1.61 to 3.66, p<0.001). Resistance to both antibiotics occurred in 6.9% (A: 5.3%, B: 15.3%). Resistance to amoxicillin was exceptional (0.6%). Children with peptic ulcer disease (80/1180, 6.8%) were older than patients without ulcer (p = 0.001).
  
  
  CONCLUSIONS
  The primary resistance rate of H pylori strains obtained from unselected children in Europe is high. The use of antibiotics for other indications seems to be the major risk factor for development of primary resistance.
authors.affiliation: Dr v Haunersches Kinderspital, Ludwig Maximilians University, Lindwurmstrasse 4, D-80337 Munich, Germany. Sibylle.Koletzko@med.uni-muenchen.de
authors.forename: S
authors.initials: S
authors.lastname: Koletzko
authors.forename: F
authors.initials: F
authors.lastname: Richy
authors.forename: P
authors.initials: P
authors.lastname: Bontems
authors.forename: J
authors.initials: J
authors.lastname: Crone
authors.forename: N
authors.initials: N
authors.lastname: Kalach
authors.forename: M L
authors.initials: ML
authors.lastname: Monteiro
authors.forename: F
authors.initials: F
authors.lastname: Gottrand
authors.forename: D
authors.initials: D
authors.lastname: Celinska-Cedro
authors.forename: E
authors.initials: E
authors.lastname: Roma-Giannikou
authors.forename: G
authors.initials: G
authors.lastname: Orderda
authors.forename: S
authors.initials: S
authors.lastname: Kolacek
authors.forename: P
authors.initials: P
authors.lastname: Urruzuno
authors.forename: M J
authors.initials: MJ
authors.lastname: Martínez-Gómez
authors.forename: T
authors.initials: T
authors.lastname: Casswall
authors.forename: M
authors.initials: M
authors.lastname: Ashorn
authors.forename: H
authors.initials: H
authors.lastname: Bodanszky
authors.forename: F
authors.initials: F
authors.lastname: Mégraud
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000658:Amoxicillin / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D024901:Drug Resistance, Multiple, Bacterial; D005060:Europe / Q000453:epidemiology; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D010437:Peptic Ulcer / Q000150:complications; D011446:Prospective Studies; D017678:Sex Distribution; D017211:Treatment Failure
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin