title: Antibiotic resistance of Helicobacter pylori in pediatric patients -- 10 years' experience.
abstract: The aim of this study was to assess the pattern of evolution of resistance to antibiotics in Helicobacter pylori isolated from children who underwent upper endoscopy with antral biopsy during a 10-year period (2001-2010). We retrospectively analyzed data of all children (n = 3,008) who underwent upper endoscopy during the observed period at the Children's Hospital Zagreb, a university tertiary medical center. We calculated the rate, antibiotic susceptibility and risk factors for the H. pylori infection in our cohort. Antral biopsy was performed in 2,313 (76.89%) patients. Altogether, 382 (16.51%) children had positive biopsy for H. pylori (histology and/or culture). There was no significant difference in the incidence of H. pylori during 10 years of observation (p = 0.21). Infected children compared to non-infected group were older (p = 0.005), and had more often antral nodularity (p < 0.0001), and duodenal ulcer (p = 0.002). Altogether, 22.4% of treatment-naïve patients had strains resistant to tested antibiotics: majority to azithromycin (17.9%), followed by clarithromycin (11.9%), metronidazole (10.1%) and amoxicillin (0.6%). In the eradication failure group, 9/11 of children had strains resistant to tested antibiotics, mostly to metronidazole (7/11), followed by azithromycin (3/11) and clarithromycin (1/11). No correlation was found between age or gender and antibiotic resistance (p = 0.32, for both). In conclusion, our data strongly support current guidelines which recommend antibiotic susceptibility testing prior to eradication therapy. Based on our results we recommend the use of amoxicillin-metronidazole-based regimen as the first-line therapy in our study population.
authors.affiliation: Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Klaićeva 16, Zagreb, Croatia. ivahojsak@gmail.com
authors.forename: Iva
authors.initials: I
authors.lastname: Hojsak
authors.forename: Tea
authors.initials: T
authors.lastname: Kos
authors.forename: Jelena
authors.initials: J
authors.lastname: Dumančić
authors.forename: Zrinjka
authors.initials: Z
authors.lastname: Mišak
authors.forename: Oleg
authors.initials: O
authors.lastname: Jadrešin
authors.forename: Alemka
authors.initials: A
authors.lastname: Jaklin Kekez
authors.forename: Amarela
authors.initials: A
authors.lastname: Lukić Grlić
authors.forename: Sanja
authors.initials: S
authors.lastname: Kolaček
mesh_terms: D000293:Adolescent; D000658:Amoxicillin / Q000494:pharmacology / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000494:pharmacology / Q000627:therapeutic use*; D017523:Croatia; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D008795:Metronidazole / Q000494:pharmacology / Q000627:therapeutic use*; D008826:Microbial Sensitivity Tests; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin